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THE 


CARE  OF  THE  BABY 

A  Manual  for  Mothers  and  Nurses 


CONTAINING 


PRACTICAL  DIRECTIONS   FOR  THE  MANAGEMENT  OF 

INFANCY  AND  CHILDHOOD  IN  HEALTH 

AND  IN  DISEASE 


BY 

J.  R  CROZER  GRIFFITH,  M.D. 

Clinical  Professor  of  Diseases  of  Children  in  the  Hospital  of  the  University  of  Penn- 
sylvania :  Physician  to  the  Children's  Hospital ;   Pediatrist  to  the  Philadel- 
phia Hospital ;  Member  of  the  American  Pediatric  Society  and  of 
the  Association  of  American    Physicians :     Corresponding 
Member  of  the  Societe  de  Pediatric  of  Paris 


THIRD  EDITION,   THOROUGHLY  REVISED 


PHILADELPHIA,   NEW   YORK,   LONDON 

W.  B.  SAUNDERS    &    COMPANY 

J903 


Electrotyped,  printed,  and   copyrighted  June,  1&9S  ;  reprinted   January,   1896; 
revised,  reprinted,  and  recopyrighted  August,  i8y8  ;   reprinted  July, 
i8'99;   November,  1900;   and  January,  1902:   revised,  re- 
printed, and  recopyrighted  February,  1903. 


Copyright,  1903,  by  W.  B.  Saunders  &  Company. 


Registered  at  Stationers'  Hall,  London,  P^ngland. 


ELtCTHOTVPEO    BY  PRCSS  Or 

WESTCOTT    1.   THOMSON.    F-HILAOA  W     B      SAUNOERS  k    CO. 


PREFACE  TO  THE   THIRD   EDITION. 


The  continued  success  of  this  "Manual"  renders  a 
third  edition  necessary.  Every  part  of  the  book  has 
been  carefully  revised,  and  the  effort  made  to  bring  it 
thoroughly  up  to  date.  A  large  number  of  illustra- 
tions have  been  added,  and  a  few,  to  which  objection 
has  been  raised,  omitted.  Several  new  recipes  have 
been  included  in  the  Appendix.  For  a  new  revision 
of  special  parts  the  author  again  expresses  his  thanks 
to  the  gentlemen  mentioned  in  the  earlier  preface,  and 
to  Dr.  J.  H.  Jopson,  his  colleague  at  the  Children's 
Hospital. 


340664 


PREFACE  TO  THE  SECOND  EDITION. 


The  very  gratifying  success  which  the  first  edition 
has  met  has  made  the  author  desirous  of  bringing  the 
present  one  thoroughly  up  to  the  demands  of  tlie  times. 
He  has  therefore  submitted  it  to  a  complete  revision, 
enlarging  it  considerably  and  adding  several  new  illus- 
trations. He  would  again  emphasize  the  statement  made 
repeatedly  throughout  the  volume,  that  the  chapter  on 
"  The  Sick  Baby"  is  not  intended  to  supplant  the  physi- 
cian. This  he  considers  impossible.  It  is  designed 
especially  for  mothers  in  emergency,  where  medical  aid 

cannot  be  obtained. 

9 


PREFACE. 


The  author  has  endeavored  in  the  following  pages  to 
furnish  a  reliable  guide  for  mothers  anxious  to  inform 
themselves  with  regard  to  the  best  way  of  caring  for 
their  children  in  sickness  and  in  health. 

The  first  chapter  of  the  book  discusses  the  hygiene  of 
pregnancy,  the  method  of  calculating  the  date  of  con- 
finement, and  similar  data.  The  characteristics  of  a 
healthy  baby  are  considered  in  the  second  chapter,  and 
the  growth  of  its  mind  and  body  in  the  succeeding  one. 
The  chapters  which  follow  relate  to  the  methods  of  bath- 
ing, dressing,  and  feeding  children  of  different  ages,  to 
the  hours  for  sleeping,  to  physical  and  mental  exercise 
and  training,  and  to  the  proper  qualities  of  the  children's 
various  nurses  and  rooms.  A  special  effort  has  been 
made  to  emphasize  details  and  to  make  them  clear, 
complete,  and  thoroughly  up  to  date. 

The  chapter  upon  the  baby's  diseases  has  been  written 

particularly  for  those  mothers  who,  through  various  cii- 

cumstances,  are   unable  to  have  a  physician  constantly 

within  a   moment's  call.     It   contains   a  description  of 

the  symptoms  by  which  we  may   know  that  disease   is 

present;  a  consideration  of  the  nursing  of  sick  children; 

a  concise  resume  of  the  commonest  diseases  of  infancy 

11 


1 2  PREFACE. 

and  cliildhood;  and  directions  for  the  management  of 
various  iiccidents,  including,  among  others,  drowning  and 
the  swallowing  of  poisons. 

Such  illustrations  have  been  inserted  as,  it  is  tliought, 
will  make  more  plain  the  meaning  of  the  text.  To  avoid 
repetition  throughout  the  book,  various  recipes  for  food 
or  medicine,  as  well  as  remarks  on  the  employment  of 
baths  of  various  sorts  in  sickness,  of  poultices,  disinfect- 
ants, massage,  and  the  like,  have  been  placed  in  the 
Appendix.  Here  also  are  tables  showing  the  proper 
proportionate  doses  at  different  ages,  the  doses  of  many 
of  the  remedies  most  commonly  given  to  children,  the 
contents  of  the  emergency  medicine  closet,  etc.  The 
numbered  references  scattered  throughout  the  text  of 
the  book  refer  to  corresponding  paragraphs  \\\  the  Ap- 
pendix. 

The  author  has  endeavored  to  make  his  statements 
plain  and  easily  understood,  yet  scientifically  accurate,  in 
the  hope  that  the  volume  may  be  of  service  not  only  to 
mothers  and  nurses,  but  also  to  medical  students  and  to 
those  practitioners  whose  opportunities  for  observing 
children  have  been  limited.  With  what  his  own  ex- 
perience with  children  has  led  him  to  believe  would 
be  most  helpful,  he  has  combined  those  teachings  in 
other  books  of  like  nature  which  have  seemed  to  him  of 
most  value;  and  he  takes  this  opportunity  to  acknow- 
ledge his  indebtedness  to  previous  writers,  not  for- 
getting the  contributors  to  the  files  of  that  excellent 
magazine  for   mothers,    "Babyhood."      He  would   also 


PREFACE.  1 3 

express  liis  grateful  thanks  to  his  colleagues  at  the  Uni- 
versity of  Pennsylvania  and  at  the  Philadelphia  Poly- 
clinic and  School  for  Graduates  in  Medicine,  Professors 
Hirst,  Roberts,  Randall,  Van  Harlingen,  and  Risley, 
who  have  revised  for  him,  with  many  valuable  sugges- 
tions, the  pages  bearing  respectively  upon  the  hygiene 
of  pregnancy  and  of  the  nursing  mother,  surgical  affec- 
tions, diseases  of  the  ear,  diseases  of  the  skin,  and  dis- 
eases of  the  eye. 


CONTENTS. 


PAGE 

Introduction = „ 17 

CHAPTER  I. 
Before  the  Baby  Comes 19 

CHAPTER  II. 
The  Baby 34 

CHAPTER  III. 
The  Baby's  Growth 46 

CHAPTER  IV. 
The  Baby's  Toii^et 68 

CHAPTER  V. 
The  Baby's  Clothes 86 

CHAPTER  VI. 
Feeding  the  Baby 116 

CHAPTER  VII. 
Sleep 16S 

CHAPTER  VIII. 

Exercise  and  Training,  Physical,  Mental,  and  Moral  .  177 

15 


l6  CONTENTS. 

CHAPTER    IX. 
The  Baby's  Nursks 197 

CHAl'TlvR  X. 
The  Bauv's  Rooms 213 

CHAl'TER  XI. 
The  vSick  Baby 236 

APPENDIX 381 


THE  CARE  OF  THE  BABY. 


INTRODUCTION. 

It  seems  often  to  be  taken  for  granted  that  the  youug 
mother  will  understand  by  a  sort  of  intuition  the  care 
which  her  baby  requires,  as  though  it  needed  no  more 
than  a  newborn  animal  of  some  lower  order  of  life.  The 
fact  is  that  such  a  little  animal,  slight  though  its  needs 
are  when  compared  with  those  of  a  baby,  has  a  parent 
which  by  instinct  is  far  better  able  to  care  for  it  than  is 
the  human  mother  for  her  child. 

That  she  knows  nothing  is  both  the  mother's  safe- 
guard and  her  danger.  Ready  and  anxious  as  she  is  to 
fit  herself  for  her  new  duties,  she  is  even  by  this  anxiety 
rendered  too  ready  to  accept  as  gospel  all  that  is  told  her 
about  the  care  of  her  infant  by  those  who  assume  to 
know,  but  who  "darken  counsel  by  words  without 
knowledge."  She  becomes  thus  the  prey  of  "old  wives' 
fables"  and  of  all  sorts  of  gratuitous  advice,  the  injuri- 
ousness  of  which  is  shown  too  late  in  the  condition  of 
the  unfortunate  child. 

A  well-informed  monthly  nurse  can  be  of  great  assist- 
ance to  a  new  mother  beginning  the  care  of  her  baby. 
Unfortunately,  not  all  nurses  are  of  this  class,  and  some 
are  full  of  absurd  and  harmful  practices  and  teach- 
ings, while  even  those  who  are  intelligent  and  well 
trained  often  err  greatly  in-  many  points.  Of  all  this  the 
mother  is,  of  course,  unable  to  judge,  unless  she  herself 

2  17 


1 8  THE   CARE    OE  THE   BABY. 

knows  what  is  right.  The  baby's  grandmother,  although 
often  of  great  assistance,  is  often  naturally  rather  rusty 
in  matters  relating  to  the  care  of  children.  ^Moreover, 
it  is  most  true,  in  the  words  of  the  old  song,  that 

"  Times  have  changed  since  then, 
And  life  is  a  diflferent  thing," 

and  many  methods  which  were  considered  entirely  cor- 
rect years  ago  have  since  been  greatly  improved  or  even 
found  to  have  been  actually  wrong.  The  mother  there- 
fore is  liable  to  find  herself,  after  the  departure  of  her 
nurse  and  phjsician,  ignorant  and  without  reliable  re- 
sources upon  which  to  draw.  Such  being  the  case,  we 
may  profitably  consider,  as  briefly  as  possible  with  due 
regard  to  completeness,  some  of  the  matters  connected 
with  babyhood  from  birth,  and  even  before  it,  up  to  the 
time  when  childhood  ceases. 

Baby  is,  indeed,  a  very  indefinite  term,  often  applied 
by  mothers  to  children  who  have  far  outgrown  their 
right  to  the  name  as  strictly  used.  But  "baby"  the 
child  still  is  to  its  mother,  unless  a  second  comer  has 
added  dignity  to  the  first-born's  position,  so  "baby"  it 
shall  be  to  us  in  our  present  study  of  its  wants  ;  for  we 
must  not  forget  that  a  child  even  of  several  years 
demands  just  as  great  care,  although  of  a  different  sort, 
as  it  did  when  still  in  arms. 

From  a  strictly  medical  standpoint  babyhood  and 
childhood  are  very  commonly  divided  into  three  periods, 
concerning  the  exact  limits  of  which  physicians  are  not 
altogether  agreed.  Most  conveniently  we  may  speak  of, 
first,  infancy^  which  extends  from  birth  to  the  age  of  two 
years;  second,  early  childhood^  from  the  age  of  two  to 
that  of  six  years;  and,  third,  later  childhood^  from  the 
age  of  six  years  to  that  of  puberty — that  is,  thirteen  to 


BEFORE    THE   BABY  COMES.  1 9 

fifteen  years.  We  shall  repeatedly  have  occasion  during 
our  study  of  the  subject  to  use  these  terms  as  thus  defined. 
No  observations  made  in  the  following  pages  concern- 
ing the  baby  when  ill  are  intended  to  do  away  with  the 
physician  any  more  than  they  are  meant  to  make  a 
mother  entirely  dependent  upon  him.  Their  object  is 
only  to  help  her  understand  what  she  can  do  without 
medical  advice,  and  how  she  shall  do  it;  when  she  shall 
call  a  physician  to  her  aid,  and  what  she  shall  do  before 
he  comes.  It  is  hoped  that  they  may  be  useful  especially 
to  the  many  mothers  who  live  far  removed  from  a  physi- 
cian. 


CHAPTER   I. 
BEFORE  THE  BABY  COMES. 

It  is  a  fact  which  ought  never  to  be  forgotten  that  the 
proper  care  of  the  baby  begins  long  before  it  is  born,  for 
to  produce  healthy  offspring  the  parents  must  themselves 
be  healthy.  Although  the  manner  of  living  always 
healthily  is  a  subject  far  beyond  the  province  of  this 
volume,  at  least  some  attention  must  be  given  here  to 
the  way  in  which  a  woman  should  live  after  she  has  dis- 
covered that  she  is  to  be  a  mother.  How  she  shall  order 
her  life  should  certainly  be  her  first  consideration,  for, 
whether  or  not  the  coming  of  the  baby  is  a  welcome 
thought,  her  responsibility  for  the  future  welfare  of  the 
child  that  is  to  be  remains  the  same.  She  has  no  right 
to  act  in  any  way  that  may  injure  another  human  life. 

Signs  of  Pregnancy. — Whether  she  is  really  preg- 
nant is  naturally  the  first  question,  and  one  concerning 
which  a  woman  does  not  ordinarily  consult  her  physician. 
There  are  a  large  number  of  presumptive  signs  of  preg- 
nancy, many  of  which  she  is  capable  of  observing  her- 


20  THE   CARE    OF  THE  BABY. 

self.  It  is  proper  to  remark  that  none  of  these  indicate 
anything  further  than  the  probable  existence  of  preg- 
nancy. There  are  only  a  i^vf  positive  signs,  and  these 
can  be  detected  by  the  physician  alone. 

The  most  striking  and  valuable  of  the  presumptive 
signs  is,  of  course,  the  cessation  of  the  monthly  periods; 
yet  even  this  is  not  entirely  reliable,  for  various  othei 
causes  may  account  for  it.  It  sometimes  happens  that 
menstruation  is  absent  for  several  months  in  early  mar- 
ried life,  and  yet  that  conception  has  not  taken  place; 
while,  on  the  other  hand,  the  monthly  periods  occasion- 
ally come  on  regularly  during  a  part  or,  rarely,  all  of 
pregnancy,  although  in  this  case  they  are  usually  scanty 
and  of  short  duration.  Finally,  a  woman  may  conceive 
while  still  nursing  and  before  menstruation  has  been 
re-established.  As  a  rule,  however,  the  cessation  of 
menstruation  in  a  married  woman  previously  regular 
indicates  pregnancy. 

Enlargement  of  the  abdomen  is  another  important 
sign,  although  usually  not  detected  before  the  fourth 
month  of  pregnancy.  A  valuable  indication  is  enlarge- 
ment of  the  breasts  with  tenderness  of  the  nipples  and  a 
decided  widening  and  browning  of  the  pink  ring,  or 
areola^  around  each  of  these.  Sometimes  a  small  amount 
of  watery  fluid  is  secreted  later.  The  enlargement  of 
the  breasts  begins  in  some  instances  in  the  second  month 
of  pregnancy,  and  becomes  quite  noticeable  in  the  fourth 
and  fifth  months.  The  alteration  of  the  areola  com- 
mences to  be  visible  by  the  end  of  the  second  month. 

"Morning  sickness"  is  a  symptom  present  in  many 
women.  It  consists  usually  in  the  occurrence  of  nausea, 
and  perhaps  vomiting,  in  the  early  morning,  but  it  some- 
times lasts  all  day.  It  appears  generally  in  the  second 
month,  occurs  every  day  or  less  frequently,  and  lasts  only 


BEFORE    THE  BABY  COMES.  21 

through  the  third  month;  but  in  bad  cases  it  may  con- 
tinue through  the  whole  period,  and  become  dangerous 
from  the  difficulty  the  patient  experiences  in  retaining 
food. 

"  Quickening"  is  a  sign  of  much  value,  but,  like  the 
others,  only  presumptive.  By  this  term  is  meant  the 
detection  by  the  mother  of  the  movements  of  the  child 
within  her.  It  was  once  thought  that  the  child  received 
life  at  this  time,  but  this  was,  of  course,  erroneous.  The 
child  is  just  as  much  alive  before  quickening  as  after- 
ward, but  its  early  movements  are  too  feeble  to  be  per- 
ceived until  four  or  four  and  a  half  months  after  concep- 
tion. The  movements  at  first  give  the  sensation  of  a 
feeble  fluttering,  but  soon  become  much  more  evident, 
and  then  feel  like  sudden,  sharp  strokes  or  kicks,  and  are 
often  the  cause  of  considerable  or  even  great  discomfort. 

There  are  a  number  of  other  less  important  presump- 
tive signs,  such  as  variations  in  appetite,  with  abnormal 
hunger,  or  ' '  longings, ' '  for  unusual  kinds  of  food. 
Again,  the  whole  disposition  may  be  changed  completely 
for  the  time,  and  she  who  was  formerly  vivacious, 
cheerful,  and  good-natured  may  become  dull  and  melan- 
cholic, full  of  the  gloomiest  forebodings,  or  excessively 
irritable.  Sometimes,  but,  unfortunately,  less  frequently, 
just  the  reverse  of  this  takes  place,  and  the  disposition  is 
at  the  best  during  pregnancy. 

The  exact  time  at  which  the  baby  may  be  expected  is 
a  matter  of  great  importance,  since  so  many  preparations 
must  be  made  for  its  arrival.  Confinement  occurs  272  to 
275  days  from  the  date  of  conception;  but,  as  this  date 
can  rarely  be  determined  exactly,  it  is  customary  to 
reckon  that  pregnancy  lasts  10  menstrual  months  of  28 
days  each — that  is,  280  days — from  the  first  day  of  the 
last  menstrual  period.     This  equals  40  weeks,  or  a  little 


22  THE   CARE    OF   THE  BABY. 

over  9  calendar  months.  A  ready  rule  for  determin- 
ing the  date  on  which  confinement  may  be  expected  is 
to  count  three  months  backward  from  the  first  day  of  the 
last  menstruation  and  to  add  seven  days  to  the  date 
obtained.  Thus,  if  the  last  period  began  on  February 
3,  three  months  backward  would  bring  it  to  November 
3,  and  seven  days  added  would  make  November  lo  the 
probable  date.  Since,  however,  the  months  are  not  of 
equal  length,  various  tables  have  been  constructed  for  a 
more  accurate  and  convenient  method  of  computing  the 
date.  The  one  upon  the  opposite  page  is  a  form  very 
commonly  in  use. 

This  method  of  reckoning  is,  of  course,  only  approxi- 
mate even  when  the  exact  date  is  known  on  which  it  is  sup- 
posed that  conception  occurred.  It  is  therefore  only  safe 
to  consider  the  calculated  date  of  confinement  as  the 
middle  of  a  period  of  two  weeks,  on  any  day  of  which 
labor  may  naturally  take  place.  Where  it  is  impossible 
to  reckon  from  the  last  menstrual  period,  it  is  custom- 
ary to  count  from  the  date  of  quickening.  Four  and  a 
half  months  from  this  date,  or  five  months  in  the  case  of 
a  woman  pregnant  not  for  the  first  time,  will  give  the 
approximate  date  of  confinement,  although  this  is  not 
very  accurate. 

Management  of  Pregnancy. — The  prospective  mother 
has,  then,  forty  weeks  during  which  she  shall  conduct 
herself  in  the  way  that  will  exert  the  most  powerful 
influence  for  good  upon  the  health  of  the  coming  little 
one.  Bathing  in  tepid  water  may  be  enjoyed  daily,  but 
very  hot  or  very  cold  baths,  sea-bathing,  and  hot  foot- 
baths are  dangerous.  Moderate  exercise  in  the  open  air  is 
important,  while  the  constant  occupancy  of  close,  heated 
rooms  is  distinctly  harmful.  All  the  pure  air  possible 
should  be  obtained.     Walking  is  beneficial,  as  is  driving 


BEFORE    THE  BABY  COMES. 


23 


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^4  THE   CARE   OF  THE  BABY. 

over  smooth  roads  or  riding  in  street  cars;  but  horse- 
back riding,  bicycling,  dancing,  driving  over  rough 
roads,  lifting,  straining  of  any  kind,  the  use  of  the 
sewing-machine,  and  all  other  violent  or  long-continued 
forms  of  exercise  ought  sedulously  to  be  avoided.  Par- 
ticular care  must  be  observed  at  the  times  at  which  the 
menstrual  period  would  naturally  occur  if  pregnancy  did 
not  exist.  Sea-voyages  are  dangerous,  on  account  of  the 
liability  to  sea-sickness  and  the  straining  which  accom- 
panies it.  There  is  a  very  injurious  custom  among  some 
women — that  of  refusing  to  go  out  of  the  house  from  the 
time  when  the  alteration  in  shape  becomes  marked. 
Even  were  concealment  of  the  figure  impossible,  health 
rather  than  appearance  should  be  the  first  consideration. 

Amusement  is,  of  course,  necessary.  There  is  no  rea- 
son why  pleasures  should  be  abandoned,  provided  they 
are  made  entirely  secondary  to  health.  So,  too,  the  fre- 
quenting of  the  theatre  and  of  similar  places  of  amuse- 
ment is  often  harmless,  especially  if  it  is  found  to  exert 
no  unduly  exciting  influence  upon  the  emotions.  In 
many  women,  however,  the  emotional  nature  is  unusu- 
ally susceptible  during  pregnancy,  and  crowded  places 
and  exciting  reading  must  be  avoided.  No  amusements 
should  be  allowed  to  interfere  with  the  obtaining  of  the 
large  amount  of  sleep  which  is  always  required  at  this 
time. 

This  brings  us  naturally  to  the  consideration  of  the 
management  of  the  mental  condition.  The  unusually 
impressionable  state  characteristic  of  pregnancy  renders  a 
woman  very  prone  to  become  the  subject  of  great  despon- 
dency. This  she  can  relieve  to  a  certain  extent  by  the 
recollection  that  it  is  only  a  symptom  shared  by  a  great 
many  others,  and  that  there  is  no  reason  for  the  convic- 
tion that  she  will  never  survive  the  birth  of  her  child. 


BEFORE    THE  BABY  COMES.  2$ 

It  is,  of  course,  much  more  difficult  to  follow  this  advice 
than  to  give  it.  Consequently  it  is  important  that  she 
avoid  adding  to  her  fears  by  listening  to  detailed  accounts 
of  the  trials  of  other  women  under  similar  conditions,  or 
by  reading  depressing  novels  or  witnessing  distressing 
sights.  The  experiencing  of  frights,  the  seeing  of  de- 
formed persons  or  animals,  the  hearing  of  bad  news,  and 
so  on — maternal  impressions.,  as  the  doctors  call  them — 
are  very  commonly  supposed  to  exert  a  powerful  influence 
in  producing  some  deformity  or  defect  in  the  child;  while 
the  looking  at  beautiful  objects,  the  listening  to  delight- 
ful music,  and  the  reading  of  elevating  books  are  also 
claimed  to  affect  favorably  the  body  or  mind  of  the  baby. 
It  is  now  admitted  generally  that  no  such  influences  are 
exerted.  The  various  instances  of  maternal  impression 
of  which  we  often  hear  are  simply  imaginary,  and  are 
coincidences  only.  The  time  at  which  most  malforma- 
tions or  other  "markings"  develop  is  very  early  in  the 
life  of  the  child  within  the  womb — much  before  the  vari- 
ous influences  which  the  mother  fears  have  generally 
been  received.  No  prospective  mother  need  give  her- 
self any  anxiety  about  the  matter.  On  the  other  hand, 
there  does  exist  the  very  certain  influence  of  inheri- 
tance. If  a  mother  wishes  her  child  to  be  healthy  of 
body  and  beautiful  of  mind,  she  must  previously  have 
cultivated  her  own  mind  and  body  through  years  of 
training. 

The  diet  during  pregnancy  should  be  generous  yet 
easily  digestible.  There  is  no  reason  why  the  usual  diet 
should  be  altered  at  all,  if  it  has  been  healthful  and  well 
assimilated,  except  that  it  is  sometimes  better  to  have 
the  evening  meal  light.  It  is  also  wiser  to  eat  meat 
only  once  a  day,  in  order  to  throw  less  work  upon  the 
kidneys.       There  is  no  truth  in  the  fancy  that  certain 


26  THE    CARE    OF   THE   BA/iV. 

articles  of  food  eaten  can  exert  any  special  inflnence 
upon  tlie  development  of  the  child  or  the  ease  of  child- 
birth. 

The  dress  is  very  important.  Tlie  skin  should  be  well 
protected  against  changes  of  temperature  by  wearing 
woollen  clothing  both  in  summer  and  in  winter.  All 
garments  must  be  loose  enough  not  to  interfere  in  the 
slightest  with  the  progressive  enlargement  of  the  abdo- 
men and  breasts.  No  woman  with  the  slightest  regard  for 
the  health  of  her  child  or  for  her  own  safety  will  resort  to 
tight  lacing  in  the  endeavor  to  conceal  her  state  as  long 
as  possible.  From  the  very  beginning  of  pregnancy  she 
should  abandon  the  corset  altogether  or  use  one  especially 
adapted  to  prevent  pressure,  and  should  avoid  circular 
garters  and  suspend  the  clothing  from  the  shoulders  as 
far  as  possible.  There  are  now  various  dress-reform  sys- 
tems on  the  market  which  answer  the  purpose  very  well, 
and  which  are  certainly  to  be  commended  during  preg- 
nancy, even  though  a  woman  cannot  persuade  herself  to 
wear  them  always.     High-heeled  shoes  ought  not  to  be 

worn,  as  they  put  a  strain  on  the 

\      back  and  the  pelvis  and  may  do 

^    serious  damage.     With  the  ex- 

,    hibition  of  proper  taste  and  skill 

/    the  dress  can   be   so   fashioned 

/     that  no  woman  need  have  cause 

„  .,  ,         ,     /        to   regard    herself    as   unfit    to 

Fig.  I. — Alxloni.i.ai  <,^,i.  '^ 

appear  in  public. 
The  abdomen  may  grow  very  large,  especially  in 
women  who  have  previously  borne  children,  and  may 
demand  some  support.  A  binder  will  give  relief,  or,  bet- 
ter still,  one  of  the  abdominal  supporters  which  are 
especially  made  for  this  purpose  (Fig.  i).  A  week  or 
two  before  confinement  the  abdomen  usually  seems  to 


BEFORE    THE   BABY  COMES.  2/ 

grow  a  little  smaller,  the  result  of  the  settling  of  the 
womb  lower  into  the  pelvis. 

The  care  of  the  breasts  must  be  commenced  early, 
since  upon  this  the  ability  to  nurse  the  baby  may  largely 
depend.  The  entire  removal  of  the  pressure  of  the  cloth- 
ing allows  the  breasts  full  opportunity  to  grow  properly. 
They  should,  however,  be  covered  warmly,  and  be  well 
supported  if  their  increasing  size  renders  their  weight 
uncomfortable.  Particular  attention  must  be  given  to 
the  nipples,  in  order  both  to  render  them  of  a  shape 
which  the  child  can  readily  grasp  and  to  make  them 
secure  later  against  the  development  of  painful  fissures. 
Sometimes  there  is  a  tendency  to  the  formation  on  the 
nipples  of  a  large  amount  of  scaling  skin.  These  scales 
must  be  washed  away  frequently  if  they  show  a  disposi- 
tion to  adhere.  If,  as  the  breast  grows,  the  nipple  is 
found  not  to  stand  out  well,  a  nipple-protector  of  some 
sort  may  be  worn  constantly  as  an  additional  safeguard 
and  aid  to  development.  This  should  not  be  done  except 
by  medical  advice.  In  cases  of  flat  nipples  it  is  frequently 
of  advantage  to  endeavor  every  day  to  pull  them  very 
gently  with  the  fingers  out  from  the  breast.  Another 
excellent  plan  for  accomplishing  this  end  is  the  use  of 
a  breast-pump.  The  form  shown  in  the  illustration 
(Fig.  2)  is  one  of  the  best,  as 
some  pumps  are  too  powerful 
and  are  apt  to  do  injury.  Trac- 
tion by  the  fingers  or  by  the 
pump  should  not  be  used  in  a 
way  to  do  the  slightest  harm, 

■'  .  Fig.  2. — Breast-pump. 

and   no  treatment   of  this   sort 

should  be  begun  until  the  last  four  weeks  of  pregnancy, 
lest  a  miscarriage  be  produced  in  women  liable  to  it. 
With  the  beginning  of  the  last  month  a  hardening  pro- 


28  THE   CARE    OF  THE  BABY. 

cess  for  the  nipples  ought  to  be  instituted,  in  order  to 
prevent  the  formation  of  fissures  later.  A  useful  plan  is 
that  of  applying,  morning  and  night,  a  tannin  solution 
(Appendix,  ']'])  to  the  nipples  with  a  piece  of  absorbent 
cotton. 

The  question  often  arises  whether  there  is  any  way  of 
determining  the  sex  of  the  coming  child,  or  any  course 
which  the  mother  can  pursue  to  influence  it.  The  very 
fact  that  so  many  different  methods  are  heard  of  is  excel- 
lent proof  that  none  of  them  are  good  for  much.  The 
truth  is  that  there  is  absolutely  no  reliable  means  known 
to  medical  science  for  discovering  in  advance  whether  the 
child  will  be  a  boy  or  a  girl,  and  not  the  slightest  power 
of  doing  anything  that  will  have  a  particle  of  influence 
in  producing  a  child  of  the  desired  sex. 

Disorders  of  Pregnancy. — There  are  many  discom- 
forts of  pregnancy  for  which  the  sufferer  herself  may  be 
able  to  do  much.  If  simple  means  do  not  avail,  she 
should  not  neglect  to  consult  her  physician,  for  there  is 
surely  no  need  of  enduring  any  inconvenience  if  it  can 
be  avoided.  Constipation  is  exceedingly  common  at  this 
time.  The  use  of  some  laxative  food,  such  as  oatmeal  por- 
ridge, green  vegetables,  figs,  oranges,  or  stewed  fruit, 
especially  prunes,  is  often  sufficiently  effective.  If  not, 
mild  drugs  may  be  used  without  danger,  as,  for  example, 
vSeidlitz  powders,  or  such  mineral  waters,  in  small  doses 
before  breakfast,  as  Hunyadi,  Rubinat,  Friedrichshall, 
and  the  like,  or  some  gentle  laxative  pill  prescribed  by 
the  attending  physician.  All  strong  purgatives  and 
patent  medicines  are  to  be  shunned,  Enemata  of  tepid 
water  may  be  used  safely.  Suj)positories  of  glycerine  or 
of  gluten,  or  very  small  glycerine  enemata  are  also  of 
service. 

Irritability  of  the  bladder  is  very  common.     It  is  relieved 


BEFORE    THE   BABY  COMES.  29 

to  some  extent  by  the  recumbent  position,  which  takes 
away  the  pressure  of  the  heavy  womb.  If  the  urine  is 
high-colored  and  causes  smarting,  a  physician's  advice 
should  be  had.  Hemorrhoids,  or  piles,  not  infrequently 
develop  in  the  later  months  of  pregnancy.  Very  hot 
fomentations  or  sponging  with  very  cold  water,  done  fre- 
quently and  followed  by  boric-acid-and-zinc  ointment  (Ap- 
pendix, 75)  often  affords  great  relief  Rest  in  the  recum- 
bent position  is  also  of  value.  If  the  bowels  are  kept  reg- 
ular and  all  straining  is  avoided,  hemorrhoids  will  not  be 
so  liable  to  form.  Varicose  veins  or  a  painful  swelling  of 
the  legs  and  lower  parts  of  the  body  is  often  very  annoy- 
ing as  pregnancy  advances.  Rest  lying  down  is  one  of 
the  best  means  of  relief,  as  is  rubbing  of  the  legs  in  an 
upward  direction.  It  is  often  necessary  to  apply  a  soft 
flannel  roller  bandage  from  the  toes  nearly  to  the  hips. 
This  should  be  done  before  getting  out  of  bed  in  the 
morning.  If  varicose  veins  grow  at  all  large,  a  physician 
should  be  consulted,  as  there  is  danger  of  their  bursting. 
Should  the  face  swell,  as  well  as  the  legs,  it  is  probable 
that  the  kidneys  are  affected.  As  this  is  a  dangerous  compli- 
cation, no  time  should  be  lost  in  obtaining  medical  advice. 
Indeed,  a  specimen  of  the  urine  should  be  sent  to  the  phy- 
sician from  time  to  time  during  pregnancy,  to  make  sure 
that  no  disorder  of  the  kidneys  is  developing  insidiously. 
A  profuse  flow  of  saliva  sometimes  occurs.  It  is  occa- 
sionally relieved  by  a  mouth-wash  of  tincture  of  myrrh  in 
water.  Toothache  is  not  infrequent.  If  neuralgic  only, 
it  is  often  relieved  by  the  use  of  a  hot- water  bag;  but, 
unfortunately,  it  is  not  always  of  this  nature.  Decay  of 
the  teeth  is  very  apt  to  occur  during  pregnancy,  and  it  is 
best  to  consult  a  dentist  occasionally,  even  though  there 
be  no  toothache.  No  painful  dental  operation  should  be 
undergone  if  it  possibly  can  be  avoided. 


30  THE    CAKE    OE   TJIE   BABY. 

It  sometimes  happens  that  the  hair  falls  out  badly  diir- 
inp;-  prep^naiicy.  This,  like  the  toothache,  may  be  only  a 
temporary  matter;  but  as  it  may  be  permanent,  it  is  well 
to  receive  treatment  for  it. 

There  is  no  reason  whatever  wh}'  a  woman  should  suf- 
fer from  mornin^^  sickness  without  at  least  making  an 
effort  to  have  it  relieved.  A  plan  frequently  effectual  is 
to  take  a  cup  of  coffee,  tea,  broth,  or  hot  milk  early  in 
the  morning,  without  sitting  up  in  bed,  and  then  to  rest 
or  to  sleep  again  for  a  short  time  before  rising.  If  the 
vomiting  persist  during  the  day,  food  ought  to  be  taken 
in  very  small  amounts  at  frequent  intervals.  Of  course, 
too,  the  food  ought  to  be  digestible  and  the  bowels  kept 
regular.  Should  the  vomiting  be  severe  and  not  be 
relieved  in  the  way  mentioned,  medicines  ordered  by  the 
physician  will  often  control  it. 

Heartburn  and  other  evidences  of  indigestion,  which 
are  quite  common  in  pregnancy,  are  often  promptly  re- 
lieved by  soda-mint,  and,  if  not,  they  should  be  prescribed 
for  by  the  attending  physician.  Leucorrhcea  is  sometimes 
decidedly  troublesome  and  even  very  irritating.  Injections 
should  not  be  used  unless  ordered  by  a  physician,  and 
then  only  with  a  very  gentle  stream  from  a  fountain 
syringe  (Fig.  3).  The  bag  of  the  syringe  must  never  be 
elevated  more  than  a  foot  or  two  above  the  hips.  Exter- 
nally, a  solution  of  boric  acid 
in  water  (Appendix,  79)  may 
be  used  for  bathing  if  there  is 
any  soreness,  followed  by  the 
application  of  an  ointment  of 
oxide  of  zinc  or  of  a  powder  of 
talc. 

F,G.  3.-Kountain  syringe.  Preparations    for    Confine- 

ment.— Finally,  we  must  consider  briefly  some  of  the  va- 
rious preparations  to  be  made  for  the  confinement  itself. 


BERORE    THE   BABY  COMES.  3 1 

The  following  list  comprises  the  articles  for  the  mother's 
use  that  should  be  provided  in  advance: 

Hand-towels. 

Ether,  one-half  pound. 

Brandy,  two  ounces. 

Vinegar,  four  ounces. 

Antiseptic  tablets  (corrosive  sublimate),  one  bottle. 

A  large,  coarse  new  sponge. 

Braided  silk,  or  a  skein  of  bobbin  (for  tying  the  cord), 
sterilized  before  being  used. 

A  fountain  syringe. 

A  new  soft-rubber  catheter. 

One  or  two  china  basins. 

A  porcelain  bed-pan. 

Absorbent  cotton,  small  package. 

Salicylated  cotton,  one-pound  package. 

Carbolized  gauze,  one  can. 

New  rubber  cloth,  one  yard  wide,  two  yards  long. 

Nursery  cloth,  eight  yards  (for  pads). 

Unbleached  muslin,  two  yards  (for  binders). 

Carbolized  vaseline,  one-ounce  bottle. 

Large  oil-cloth  or  old  rug  (to  protect  the  carpet). 

Large  safety-pins. 

Fluid  extract  of  ergot  (bought  one  week  before  con- 
finement). 

Hot  water  in  abundance  (at  time  of  confinement). 

The  room  which  the  prospective  mother  will  occupy 
will  ordinarily  be  her  usual  bed-room.  It  ought  to  be 
light,  well  ventilated,  and  large.  It  is  a  great  conve- 
nience if  there  is  a  communicating  room  for  the  monthly 
nurse,  as  this  leaves  to  the  mother  the  exclusive  use  of 
her  own.  The  bed,  when  ready  for  the  confinement, 
should  be  so  situated  that  it  is  out  of  draughts  and  that 
its  sides  are  not  against  the  wall.  The  mattress  should 
be  of  hair  or  other  firm  material,  but  certainlv  not  of 


32  THE   CARE    OF   THE   BABY. 

feathers;  and  extending  entirely  across  it,  at  the  level  of 
the  hips,  there  should  be  the  strip  of  rubber  cloth. 
Over  this  is  spread  the  lower  sheet  of  the  bed,  and  finally, 
on  the  spot  where  the  hips  will  lie,  a  protecting  pad  for 
the  purpose  of  catching  and  absorbing  the  discharges. 
This  pad  should  be  a  yard  or  more  square.  It  is  made  of 
nursery  cloth,  and  is  pinned  to  the  sheet  with  safety-pins. 
Three  or  four  should  be  provided.  Under  the  bed  is 
placed  the  oil-cloth  or  old  rug.  Many  of  these  arrange- 
ments for  sparing  the  bed  and  the  floor  are  sometimes 
substituted  by  special  rubber  apparatus. 

The  "  nursery  cloth  "  referred  to  consists  of  two  layers 
of  muslin  with  a  layer  of  cotton  quilted  between  them. 
It  may  be  bought  in  the  shops.  It  should  be  boiled  for 
half  an  hour  in  a  clothes-boiler,  dried  thoroughly,  pinned 
up  in  a  sheet,  and  put  away  out  of  the  dust. 

The  napkins  which  the  mother  will  use  should  not  be 
made  until  just  before  the  confinement.  She  must,  when 
making  them,  see  that  her  hands  are  very  clean,  and  she 
should  put  them  away,  when  finished,  in  a  clean  place 
free  from  dust.  It  is  far  better,  indeed,  that  the  nurse 
make  the  napkins  as  needed.  Each  one  is  composed  of 
an  oblong  wad  of  salicylated  cotton  enveloped  in  carbol- 
ized  gauze  folded  in  the  usual  form.  Three  or  four  dozen 
will  probably  be  needed.  All  soiled  napkins  must  be 
burnt  at  once. 

The  abdominal  bandages  or  "binders,"  of  which  there 
should  be  several,  are  composed  of  washed  unbleached 
muslin  half  a  yard  wide  and  two  or  three  feet  long. 
The  ligature  for  tying  the  cord  should  be  soaked  in  sub- 
limate solution  before  being  used  (Appendix,  82). 

If  the  nurse  is  in  the  house  some  time  before  the  con- 
finement, as  she  should  be,  she  will  decide  when  to  send 
for  the  physician,  and  thus  relieve  the  patient  of  respon- 
sibility in  the  matter.     If  she  has  not  yet  come,  the  pro- 


BEFORE    TFfE    BABY  COMES.  33 

spective  mother  will  suspect  that  labor  is  about  to  begin 
from  the  occurrence  of  Iriic  pains.  These  are  felt  either 
in  the  back  or  in  front,  last  a  quarter  to  half  a  minute, 
.uid  come  on  rather  reg;ularl\'.  The  intervals  between 
them  at  first  last,  perhaps,  three-quarters  of  an  hour,  but 
gradually  grow  shorter,  while  the  pains  grow  more  severe 
and  center  more  and  more  in  the  back.  There  is  often  a 
ilight  discharge  of  blood  (sometimes  called  a  "show"), 
which  is  almost  a  positive  proof  that  labor  is  about  to 
commence.  False  pains,  as  they  are  usually  called,  quite 
frequently  occur  at  intervals  during  the  two  weeks  before 
confinement.  They  are  situated  in  the  abdomen  and 
have  no  element  of  regularity  about  them. 

The  "bag  of  waters"  is  a  sac  containing  a  peculiar 
fluid  in  which  the  child  floats.  Its  rupture  is  indicated 
by  a  continuous  flowing  or  sudden  gush  of  liquid.  Should 
this  happen,  the  physician  must  be  sent  for  at  once,  even 
though  there  has  been  little  or  no  pain.  The  rupture 
may  take  place,  it  is  true,  some  days  before  the  child  is 
born,  but  much  more  frequently  it  does  not  occur  until 
labor  has  really  commenced,  or  even  is  nearly  over. 

At  the  very  beginning  of  the  confinement  the  bowels 
ought  to  be  emptied  by  an  enema  unless  they  have  been 
moved  just  before. 

After  labor  is  actually  under  way  and  the  physician 
has  arrived  the  patient  has  no  further  responsibility,  and 
we  need  not  consider  the  treatment  that  she  requires  or 
the  various  steps  in  the  birth  of  the  child.  After  its  birth 
her  physician  will  still  attend  to  her  needs  and  prescribe 
the  form  of  diet  best  suited  to  her.  When  she  is  out  of 
bed  again  and  thrown  on  her  own  responsibility,  her 
chief  care  for  herself  with  regard  to  the  baby  must  be  to 
provide  for  it  a  suitable  supply  of  milk.  This  can  be 
discussed  more  conveniently  in  the  chapter  which  treats 
of  Feeding  the  Baby. 

3 


34  THE    CAKE    OE   THE   BABY 

CHAPTER   II. 
THE  BABY. 

The  new-born  baby  is  certainly  not  an  object  of 
beauty.  Even  its  mother  could  hardly  think  it  so,  did 
she  see  it  at  the  moment  of  its  birth,  before  it  has  expe- 
rienced the  improving  influences  of  its  first  toilet — wet 
and  more  or  less  covered,  as  it  is,  with  a  peculiar  whitish, 
waxy  substance.  After  it  is  washed  and  dressed  its  ap- 
pearance even  yet  cannot  be  called  altogether  prepossess- 
ing. Still,  despite  its  lack  of  beauty,  its  mother  loves  it 
and  is  naturally  anxious  to  know  whether  it  is  "  all  right. ' ' 
]\Iany  times  afterward  will  she  be  fortunate  if  she  can  tell 
whether  all  is  still  right  v/itli  it.  As  without  a  knowledge 
of  how  a  baby  of  any  age  should  look  and  act  it  is  impos- 
sible to  recognize  illness  developing,  our  first  duty  is  to 
pass  in  review  the  characteristics  of  a  healthy  child — 
often  called  the  features  of  health. 

A  healthy  and  well-developed  new-born  infant  should 
be  plump  and  firm,  with  its  bones  well  covered  and  with 
a  soft  and  extremely  delicate  skin.  This  remarkable 
softness  is  due  in  great  part  to  the  presence  everywhere 
of  a  coating  of  fine  down,  which  is  sometimes  scarcely 
visible,  sometimes  quite  abundant.  The  skin  is  of  a 
decidedly  reddish  color,  and  only  when  the  baby  is 
suffering  from  some  disease  or  when  it  is  cold  does  it 
become  mottled  or  bluish.  Cold  is  the  most  frequent 
cause  of  this,  for  a  baby  has  but  feeble  vitality  as  com- 
pared with  an  adult. 

The  baby  should  weigh  anywhere  from  6i<  to  lo 
pounds,  the  average  being  'jYz  pounds.'  Its  length  is 
about  19  inches,  with  a  range,  however,  of  from  16  to  22 
inches.     Any  child  which  conies  within  these  limits  of 


THE   BABY.  35 

weight  and  length  is  to  be  called  normal.  Occasionally 
these  figures  are  much  exceeded,  but  not  often.  It  must 
be  remarked,  too,  that  a  child  may  be  thin  when  born, 
and  yet  not  be  actually  unhealthy. 

Before  the  child  is  a  week  old  its  lobster-red  color  often 
fades  into  a  no  more  attractive,  yellowish-red  tint  which 
is  due  to  the  presence  of  a  very  slight  degree  of  jaundice. 
This  is  of  very  common  occurrence,  and  is  not  to  be 
considered  as  evidence  of  disease.  In  this  first  week, 
also,  the  long  down  begins  to  fall  out,  and  a  more  or  less 
extensive  shedding  of  the  skin  takes  place,  generally  in 
the  form  of  fine  scales,  but  sometimes  in  shreds.  This 
shedding  always  occurs,  and  may  last  a  week  or  more, 
although  with  many  babies  it  is  almost  imperceptible. 

Generally  before  the  baby  is  two  weeks  old  the  yel- 
low tint  has  disappeared  and  the  skin  has  taken  on  the 
real  "baby"  character  which  is  so  much  admired,  and 
which  only  needs  to  be  seen  to  be  appreciated.  It  is  then 
of  a  clear,  soft,  pinkish-white  tint,  with  the  palms,  soles, 
and  cheeks  of  a  deeper  rose.  A  warm  bath  or  rubbing 
the  skin  renders  the  whole  body  reddish. 

There  are  many  other  features  about  the  body  of  a 
healthy  baby  with  which  we  must  acquaint  ourselves, 
for,  although  they  may  seem  rather  uninteresting,  they 
are  matters  of  the  greatest  importance. 

The  head  is  remarkably  large  as  compared  with  the 
rest  of  the  body,  being,  indeed,  nearly  as  long  from  the 
crown  to  the  chin  as  is  the  trunk.  Immediately  after 
birth,  if  this  has  been  difficult  or  prolonged,  the  head 
is  sometimes  found  squeezed  into  a  shape  which  is  start- 
ling, it  is  true,  but  which  need  cause  no  anxiety.  (See 
Chapter  XI.,  p.  297.) 

The  contour  of  a  baby's  head  as  seen  from  above 
should  be  round  or  oval.     At  the  back  of  the  head  and 


36 


THE    CARE    OF   THE   BABY. 


at  a  point  just  ])chind  the  forehead  are  two  spots  where 
there  is  no  firm  bone  present,  and  only  the  skin  and  a 

thin  membrane  cover  the  brain, 
which  can  be  seen  to  pulsate 
through  them.  These  spots  are 
called  the  anterior  and  posterior 
fontanelles  (Fig.  4).  The  first, 
the  one  just  back  of  the  fore- 
head, is  the  larger  of  the  two, 
and  is  the  only  one  to  the  size 
of  which  the  mother  need  give 
any  attention.  It  is  diamond- 
shaped,  and  should  measure 
from  one-half  to  one  inch  in 
length,  and  about  half  an  inch 
Fig.  4.-infant's skull: anterior  "^  diameter  at  birth.  It  should 
fontaneiie  above ;  posterior  fonta-  neither  be  mucli  depressed  nor 
neiie  below.  bulge    mucli.      The    new-born 

baby  sometimes  has  a  very  considerable  amount  of  hair 
on  its  head.  The  mother  need  feel  no  alarm  at  seeing 
this  fall  out  to  a  great  extent  in  a  short  time.  Its  nails, 
too,  are  well  formed  at  birth,  and  grown  fully  out  to  the 
ends  of  the  fingers. 

The  tongue  during  the  first  week  of  life — and,  indeed, 
up  to  the  time  when  saliva  becomes  more  abundant — is 
more  or  less  covered  with  a  whitish  fur.  This  is  no  sign 
of  digestive  disturbance,  but  is  probably  the  result  of  the 
greater  dryness  of  the  mouth  present  at  this  time  of  life. 
The  chest  of  a  baby  is  poorly  developed  as  compared 
with  the  head,  and  its  circumference  is  somewhat  less. 
The  shoulders  and  hips  are  narrow,  and  their  girth  is  at 
first  less  than  that  of  the  head.  On  the  other  hand, 
the  abdomen  is  large  and  prominent,  the  result  chiefly 
of    the   extraordinarily    large    liver   which    a   new-born 


Plate  I. 


Baby  a  few  weeks  old,  showing  the  natural  curve  of  the  legs  with  the  bending  in  of  the 
soles.     (From  a  photograph.) 


THE   BABY.  37 

child  possesses.  The  arms  are  comparatively  short,  and 
the  legs  particularly  so.  The  latter  measure  very  little 
more  than  the  length  of  the  trunk. 

Every  mother  should  remember  that  the  baby  at  first 
has  crooked  legs,  or  rather  what  seem  to  be  so,  and  that 
there  is  no  cause  for  alarm  on  this  account.  It  has  the 
peculiar  monkey-like  power  of  turning  its  feet  in  in  a 
way  which  brings  the  soles  rather  closely  together.  The 
accompanying  illustration  of  a  perfectly  healthy  and  well- 
developed  baby  a  few  weeks  old  (PI.  I.)  shows  the  natural 
bowing  of  the  legs. 

Of  course  there  are  such  things  as  clubbing  of  the  feet 
and  bowing  of  the  legs,  but  these  are  actual  deformities 
of  the  joints  and  bones,  not  deceptive  appearances  merely. 

All  these  various  peculiarities  of  shape  which  we  have 
been  considering  change  gradually  with  the  growth  of 
the  child.  We  shall  need  to  study  them  more  fully  in 
the  next  chapter. 

In  addition  to  the  features  mentioned,  it  is  necessary 
to  know  something  of  the  expression  of  face  and  the 
position  and  gestures  of  a  healthy  child.  The  face  of  a 
very  young  baby  when  awake  has  an  expression  of 
wondering  surprise.  The  look  of  intelligence  which  is 
there  is  only  an  apparent  one.  It  is  a  pity,  perhaps,  to 
shatter  a  mother's  fancy  that  her  child  notices  what  is 
going  on,  recognizes  her,  and  expresses  pleasure  at  her 
approach;  still,  the  truth  is  that  the  baby  at  birth  is 
about  as  intelligent  as  the  sensitive  plant,  the  leaves  of 
which  automatically  close  when  touched.  Like  the 
plant  with  its  leaves,  the  baby  automatically  closes  its 
mouth  and  nurses  without  knowing  that  it  docs  it. 

The  color  of  the  eyes  is  generally  a  very  indefinite  one 
— a  sort  of  blue  in  all  babies.  However  much  they  may 
be   supposed   at   first   to   resemble    the    father's    or   the 


38  THE    CAKE    OF   TJJE  BABY. 

mother's,  a  cliaiiQe  to  a  lighter  or  a  darker  hue  is  liable 
to  occur  at  the  age  of  seven  or  eight  weeks.  When  a 
baby  of  any  age  is  asleep  its  eyes  are  entirely  shut  and 
the  expression  is  that  of  peaceful  repose. 

The  posit io)i  of  its  body,  too,  at  this  time  is  that  of 
entire  and  graceful  relaxation.  The  head  is  u.sually 
turned  slightly  to  one  side,  and  breathing  goes  on  almost 
imperceptibly  and  without  any  movement  of  the  nostrils. 
In  the  waking  state  the  new-born  baby  is  comparatively 
still,  except  for  a  really  remarkable  disposition  to  grasp 
anything  with  which  its  hand  comes  in  contact.  In  a 
very  short  time,  however,  it  becomes  when  awake  almost 
the  embodiment  of  perpetual  motion,  the  legs  and  arms 
being  in  nearly  constant  although  purposeless  action. 

The  first  act  of  the  new-born  child  usually  is  to  cry. 
No  sound  is  so  pleasing  to  the  attending  physician  as  a 
good,  lusty  cry  from  the  little  newcomer,  for  it  shows 
that  it  has  well  entered  on  the  use  of  the  lungs  which 
have  hitherto  been  inactive,  and  that  it  has  plenty 
of  strength  for  all  the  functions  of  its  new  life.  The 
mother  likes  to  hear  it  too — better  than  she  will  later. 
There  is  good  cause  for  the  baby's  crying  at  such  a  time, 
for  the  change  from  its  previous  existence  to  the  contact 
with  the  chilling  external  air,  and  the  comparatively 
rough  handling  which  it  receives,  must  constitute  an  ex- 
ceedingly disagreeable  experience.  The  sound  soon 
ceases,  however,  after  the  child  is  washed  and  dressed  and 
put  to  rest.  It  may  be  taken  as  a  positive  rule  that  a 
baby  does  not  cry  without  some  reason,  h.  cause  exists, 
although  it  may  be  a  trivial  one,  and  the  cry  is  the  baby's 
only  audible  means  of  expressing  its  dissatisfaction  with 
its  state.  The  cry  should  be  clear,  and  any  alteration 
from  the  normal  character  is  a  valuable  indication  that 
some  diseased  condition  is  present.     What  these  altera- 


THE  BABY.  39 

tions  are,  and  what  they  mean,  we  shall  consider  when 
we  come  to  study  the  baby's  illnesses.  It  is  a  curious 
fact,  which  may  be  mentioned  here,  that  a  young  infant 
sheds  no  tears,  no  matter  how  hard  it  may  cry. 

Finally,  we  must  consider  some  matters  connected 
with  certain  of  the  functions  of  life — namely,  breathing, 
the  action  of  the  heart  as  shown  by  the  pulse,  the  opera- 
tions of  the  bowels,  the  voiding  of  urine,  and  the  condi- 
tion of  the  temperature. 

The  respiration  during  sleep  is  quiet  and  comparatively 
regular.  In  the  waking  hours  it  exhibits  a  very  great 
irregularity,  which  is  present  up  to  several  years 
of  age,  although  most  marked  in  the  first  twelve 
months.  The  child  often  holds  its  breath  a  moment, 
yet  apparently  without  any  effort  or  any  intention  of 
doing  so.  A  number  of  quick  breaths  may  occur  to- 
gether, or  perhaps  a  number  of  slow  ones.  No  weight 
whatever  is  to  be  attached  to  this  peculiarity,  for  it  is 
entirely  characteristic  of  infancy  and  early  childhood. 

The  respiration  in  children  up  to  the  age  of  puberty  is 
largely  what  is  called  abdominal ;  and  this  applies  to 
girls  as  well  as  to  boys.  The  heaving  movement  is  seen 
to  a  large  extent  in  the  abdomen,  the  chest  moving  to  a 
lesser  degree.  After  girls  reach  the  age  of  from  thirteen 
to  fifteen  years  the  respiration  is  more  from  the  chest,  as 
it  is  in  women. 

The  rapidity  of  breathing  in  children  varies  with  the 
age,  as  can  be  seen  from  the  following  table: 

Number  of  Respirations  per  Minute. 
At  birth  and  for  the  first  2  or  3  weeks  .    .  30  to  50,  average  about  4°. 
During  the  rest  of  the  first  year  .    .    .    .  25  to  35,  average  about  30. 

1  to  2  years      About  28. 

2  to  4  years About  25. 

4  to  15  years 20  to  25. 

Adult  Hfe 16  to  18. 


40  THE   CARE    OF   THE   BABY. 

All  these  rates  are  from  one-fifth  to  one-quarter  less  when 
the  child  is  asleep,  at  least  up  to  the  age  of  four  years, 
although  after  this  the  breathing  is  still  slightly  slower 
during  sleep.  The  numbers  given  are  average  and 
approximate  ones  only,  for  the  rate  varies  extraordinarily 
in  young  children.  To  estimate  the  frequency  of  the 
breathing  we  may  watch  the  in-and-out  movements  of 
the  abdomen,  or  perhaps  put  the  hand  lightly  there  and 
feel  them.  It  is  necessary  to  avoid  the  slightest  excite- 
ment, since  this  increases  the  rapidity  very  greatly. 
During  sleep  is  an  excellent  time  for  making  the  obser^ 
vation,  allowing  for  the  differences  mentioned. 

^he  pulse  shares  to  a  great  extent  the  irregularity  of 
the  respiration,  and  the  slightest  excitement,  such  as  cry- 
ing or  even  sucking,  increases  its  rate  so  much  that  no 
conclusions  can  be  drawn  from  any  observations  made 
under  such  conditions.  The  less  the  age  the  truer  this 
statement  is;  and  a  mother  consequently  need  feel  no 
anxiety  if  her  child  of  two  or  three  years  or  less  has  a 
temporary  pulse-rate  of  20,  30,  or  even  more  beats  per  min- 
ute above  the  standard.  Not  only  is  the  pulse  influenced 
by  excitement  of  any  sort,  but  even  when  the  baby  is 
asleep  or  is  perfectly  quiet  a  decided  irregularity  can  be 
perceived,  which  is  perfectly  natural  and  to  be  expected, 
although  it  would  be  abnormal,  and  perhaps  dangerous, 
in  an  adult.  The  pulse  may  be  felt  at  the  wrist,  or,  when 
this  does  not  succeed — as  it  often  will  not  in  the  first 
weeks  of  life — in  the  neck  or  over  the  heart  itself 
Another  very  good  method  is  to  watch  the  beating  of  the 
fontanelle. 

The  table  which  follows  shows  the  normal  average 
pulse-rate  at  different  ages. 


THE   BABY.  41 


Number  of  Pulse-beats  per  Minute. 

At  birth 130  to  150 

First  month 120  to  140 

I  to  6  months About  130 

6  months  to  i  year      About  120 

1  to  2  years no  to  120 

2  to  4  years 90  to  1 10 

6  to  10  j-ears 90  to  100 

10  to  14  years 80  to  90 

Adult  life 72 

This  table  gives  the  piilse-rates  in  children  who  are  awake 
but  perfectly  quiet.  The  figures  are  even  more  approxi- 
mate than  in  the  case  of  respiration,  owing  to  the  great 
tendency  to  irregularity  referred  to,  and  to  the  extreme 
difficulty  experienced  in  finding  the  quiet  state  desired. 
For  this  reason  the  best  time  to  count  the  pulse  is  when 
the  child  is  asleep.  We  must  remember,  however,  that 
sleep  produces  a  decided  lessening  of  the  speed.  In  chil- 
dren under  nine  years  of  age  the  slowing  is  16  or  20  beats 
per  minute;  from  nine  to  twelve  years  it  is  about  8  beats; 
and  from  twelve  to  fifteen  years,  2  beats.  The  rapidity 
of  the  pulse  is  slightly  greater  in  girls  than  in  boys  of 
equal  age,  but  the  difference  is  not  very  material. 

The  boivels  of  a  new-born  baby  are  generally  opened 
once  or  twice  during  the  first  day  of  life.  The  passages 
of  the  first  two  or  three  days  consist  of  a  peculiar  thick 
and  sticky,  odorless,  blackish  or  greenish-black  sub- 
stance called  meconium.  This  was  produced  in  the  bowel 
before  the  birth  of  the  child.  When  the  flow  of  mother's 
milk  has  been  established  the  passages  become  canar}-- 
yellow  in  color,  of  the  consistency  of  thick  cream,  have 
very  little  odor,  frequently  contain  small  masses  of  undi- 
gested milk  if  the  baby  is  getting  more  nourishment  than 
it  can  entireh'  assimilate,  and  number  two  to  four  in 
twenty-four  hours.     Gradually  the  frequency  diminishes, 


42  THE    CARE    OE   THE   BABY. 

SO  that  from  the  age  of  six  weeks  or  two  months  to  that 
of  two  years  there  are  usually  only  one  to  three  move- 
ments daily,  while  the  color  is  a  trifle  darker  yellow, 
the  consistency  greater,  and  the  odor  rather  more  fecal. 
Very  often  a  slight  greenish  tinge  develops  a  short  time 
after  the  movement  has  occurred.  This  is  entirely  nor- 
mal. It  is  only  after  the  age  of  two  years,  and  when  the 
diet  has  been  considerably  varied,  that  the  passages 
become  completely  formed  and  of  a  distincth-  fecal  odor. 
There  should  never  be  any  fetid  odor  from  a  natural  and 
perfectly  healthy  bowel-movement  of  a  baby. 

Nevertheless,  the  number  of  movements  of  the  bowels 
may  vary  considerably  from  the  statements  just  made 
without  indicating  actual  ill-health.  There  may  be  no 
more  than  one  or  two  movements  daily,  even  in  early 
life,  or  they  may  number  even  five  or  six,  and  yet  not 
constitute  diarrhoea  unless  their  character  is  also  changed. 

The  urine  of  a  young  healthy  baby  is  generally  almost 
like  water  in  appearance,  unirritating,  has  very  little 
odor,  and  leaves  no  stain  upon  the  diaper.  x\lthough  it  is 
generally  passed  within  the  first  twenty-four  hours,  it  not 
infrequently  happens  that  the  bladder  is  not  emptied 
during  the  whole  first  day  of  life.  This  need  not  occa- 
sion any  alarm,  provided  the  baby  is  resting  comfortably 
and  is  evidently  in  no  distress.  Just  how  often  in  twenty- 
four  hours  a  baby  usually  passes  water  it  is  very  difficult 
to  state.  Not  only  does  it  vary  greatly  with  different  chil- 
dren, but  with  the  day  as  well,  depending  upon  the  tem- 
perature of  the  air  or  upon  the  amount  of  nourishment 
taken.  The  average  is  probably  six  to  ten  times  a  day, 
but  there  may  at  times  be  an  evacuation  of  urine  every 
hour,  or  perhaps  not  for  even  ten  hours,  and  yet  the 
child  be  in  perfect  health.  As  age  increases  and  control 
of  the  bladder  is  acquired  the  frequency  diminishes  to 
about  six  times  a  day  or  less. 


THE   BABY.  43 

The  amount  of  urine  evacuated  varies  with  the  age, 
although  not  exactly  in  proportion  to  it.  The  following 
table  shows  approximately  the  amounts  for  different 
periods  of  life: 

Amount  op  Urine;  Passed  Daily. 

Birth  to  2  j^ears 8  to  12  ounces. 

2  to  5  years       15  to  25       " 

5  to  10  j^ears 25  to  35      " 

10  to  15  years 35  to  40       " 

Adult  life 52      " 

Every  mother  should  be  acquainted  with  the  normal 
tcjuperature  of  a  baby,  in  order  that  she  may  be  able  to 
appreciate  the  changes  occurring  in  disease.  There  is  no 
way  of  determining  this  except  by  the  clinical  thermom- 
eter, for  it  is  impossible  for  her  even  to  approximate  it 
satisfactorily  by  simply  placing  her  hand  upon  the  skin. 
Even  the  fact  that  a  baby's  hands  and  feet  are  cold  is  not 
sufficient  proof  that  it  is  not  having  high  fever  at  the 
same  time.  A  clinical  thermometer  should  be  in  every 
household,  and  the  mother  should  thoroughly  understand 
its  use  and  should  employ  it  whenever  the  child  seems  at 
all  ailing.  She  should  equally  understand  how  not  to 
worry  herself  unnecessarily  about  what  it  shows  her. 
The  instrument  commonly  used  is  self-registering ;  that 
is,  the  top  of  the  column  of  mercury,  which  indicates 


Fig.  5. — Clinical  thermometer. 

the  temperature  attained,  will  remain  at  the  highest 
point  reached,  even  after  the  thermometer  is  removed 
from  the  child.  The  instrument  is  general!}-  entirely 
of  glass,  without  any  outside  casing,  and  the  Fahrenheit 
scale  is  engraved  upon  the  tube,  dividing  it  into  degrees 
and  fifths  of  a  degree  (Fig.  5).     The  arrow  on  the  tube 


44  THE    CARE    OF   THE   BABY. 

merely  points  to  what  is  considered  normal — that  is, 
98f  °.  It  may  be  disregarded  altogether  in  making  the 
reading.  The  ordinary  pattern  is  stronger  than  the  more 
delicate  so-called  "one-minute"  thermometer.  The 
latter  is,  however,  to  be  preferred  for  children,  since  it 
has  the  great  advantage  of  requiring  a  shorter  time  to 
register — an  important  matter  when  the  child  objects 
greatly  to  its  use.  Yet  it  would  be  insufficient  to  depend 
on  the  full  elevation  being  attained  in  just  one  minute. 
A  somewhat  longer  time  is  usually  required.  Most  of 
the  instruments  have  the  stem  so  .shaped  that  the  front 
acts  like  a  lens  and  magnifies  the  column  of  mercury, 
in  order  to  make  the  reading  more  easy. 

The  temperature  may  be  taken  in  the  arm-pit,  mouth, 
or  bowel.  The  groin  does  not  give  sufficiently  accurate 
results.  The  first  locality  .should  ordinarily  not  be 
chosen  for  children,  as  the  results  obtained  are  often  very 
misleading,  owing  to  the  difficulty  experienced  in  bring- 
ing and  keeping  the  surfaces  of  skin  close  together  and 
thus  excluding  the  air.  The  thermometer  may  be  placed 
in  the  mouth  of  children  of  five  or  six  years,  who  can  be 
trusted  not  to  bite  upon  it.  To  employ  it  the  child 
should  be  seated  or,  still  safer,  made  to  lie  down.  The 
instrument  should  now  be  held  firmly  by  its  upper  por- 
tion between  the  thumb  and  forefinger,  and  be  swung  or 
shaken  forcibly  until  the  column  of  mercury  is  made  to 
\lescend  in  the  tube  far  enough  to  bring  its  upper  extrem- 
ity to  95°  or  thereabouts.  The  child  now  receives  the 
bulb  under  the  tongue,  and  is  told  to  close  the  lips  upon 
it,  but  not  to  bite  it.  Very  often  the  order  will  be  under- 
stood better  if  the  child  is  bidden  to  hold  the  instrument 
with  one  hand  and  to  .suck  it  "like  a  stick  of  candy" — 
that  beinof  an  action  with  which  everv  child  .seems  famil- 
iar.     The  thermometer  should  be  left  in  place  at  least 


THE    BABY.  45 

four  minutes,  or,  in  the  case  of  tlic  "  onc-niimite  "  ther- 
iiioiiieter,  two  minutes. 

With  younger  children  or  those  who,  through  sickness, 
cannot  be  entrusted  with  the  thermometer  in  the  mouth, 
the  temperature  is  more  conveniently  taken  in  the  bowel. 
To  do  this  the  child  is  laid  upon  its  back  or  side  in  the 
lap  or  on  the  bed  and  its  thighs  are  flexed.  The  bulb,  pre- 
viously oiled,  is  then  gently  inserted  an  inch  or  two  by  a 
screwing  movement.  The  procedure  is  simple,  painless, 
and  free  from  danger.  Although  it  is  better  to  be  sure 
that  there  are  no  fecal  contents  in  the  rectum,  it  is  not 
necessary  to  remove  them  by  injection,  provided  the  ther- 
mometer be  left  in  place  somewhat  longer.  If  no  feces 
are  present,  the  time  mentioned  for  the  mouth  is  suf- 
ficient. The  thermometer  should  always  be  washed 
thoroughly  with  soap)  and  cold  water  after  use,  disinfected 
with  a  boric-acid  solution  (Appendix,  79),  shaken  down 
well,  and  placed  in  its  case. 

The  normal  temperature  of  a  baby  fluctuates  consider- 
ably during  the  first  week  or  more  of  life,  and  is  nor- 
mally then  about  99°  F.  lyater  it  settles  down  to  from 
98°  to  99°  F.,  as  in  the  adult.  We  must  remember, 
however,  that  children  are  liable  to  have  their  tem- 
perature elevated  some  fifths  of  a  degree  by  slight  causes, 
such  as  hard  crying  or  struggling  against  the  use  of  the 
instrument,  or  even  by  the  taking  of  a  large  amount  of 
nourishment,  although  these  variations  are  not  so  apt  to 
occur  as  in  the  case  of  the  respiration  and  the  pulse. 
There  is,  besides  this,  a  regular  variation  during  the 
twenty-four  hours,  which  is  present  in  adults  also,  but 
is  less  marked.  The  normal  temperature  rises  slightly 
in  the  forenoon,  reaches  its  highest  point  in  the  after- 
noon, begins  to  sink  again  in  the  evening,  and  is  at  its 
lowest   by    midnight   or   in    the    early    morning   hours. 


4^  TIIF.    CARE    OF    THE    BARY. 

There  niny  tliiis  be  a  difFerence  of  one,  two,  or  even 
three  degrees  between  the  readings  at  different  times 
of  the  day.  It  is  important  to  bear  all  this  in  mind, 
or  we  might  become  very  unnecessarily  worried.  In 
spite  of  the  quite  considerable  variations  during  the  day 
in  early  infancy,  we  need  feel  no  uneasiness  until  the 
temperature  falls  to  97°  or  96°,  or  rises  to  i(X)°  or  more. 
It  is  only  when  a  temperature  of  100°  is  attained  that 
wc  talk  of  fever.  The  signification  of  febrile  tempera- 
tures in  children  we  shall  consider  when  we  study  the 
Sick  Baby,  in  Chapter  XL 

Most  of  what  has  been  said  in  this  chapter  relates  to 
the  baby  while  still  very  young.  All  the  features  de- 
scribed alter  gradually  with  the  increasing  age  of  the 
child.  The  subject  of  the  growth  of  the  baby  with  the 
interesting  changes  which  take  place  is  so  important  that 
it  must  be  considered  iu  a  chapter  of  its  own,  although  a 
few  of  the  progressive  alterations,  including  those  in 
pulse,  respiration,  temperature,  urine,  and  bowel-move- 
ments, have  been  more  conveniently  discussed  iu  this 
chapter. 


CHAPTER   III. 
THE  BABY'S  GROWTH. 

Fortunately,  the  baby  grows;  for,  charming  as  is 
its  early  helplessness,  how  much  more  delightful  to 
watch  the  development  of  its  beauty,  strength,  and  in- 
telligence !  What  mother  will  forget  her  happiness  at 
the  baby's  first  tooth,  its  first  step,  and  its  first  word  ! 

But  all  this  progress  comes  only  gradually;  it  is  bit  by 
bit  that  the  child  grows.  By  groiv/h  here  is  not  meant 
increase  in  size  and  weight  alone,  important  as  these  are. 


THE   BABY'S   GROlVril  47 

The  baby's  mind  steadily  grows,  and  the  changes  in  it 
are  even  more  remarkable  than  those  of  the  body.  The 
watching  of  this  mental  development  is  most  interesting 
if  we  reall)-  appreciate  just  what  the  baby  knows  and  just 
what  it  ought  to  know  at  different  periods  of  life. 

Besides  all  this  growth  of  what  is  already  present  to 
some  extent,  new  acquisitions  appear,  such  as  the  teeth, 
tears,  saliva,  and  the  ability  to  walk;  and  still  other 
changes  go  on  which  are  not  actually  visible,  such  as 
alterations  in  the  digestive  powers. 

When  the  baby  is  just  born,  and  during  the  first  few 
days  of  life,  it  is,  as  stated  in  the  preceding  chapter,  very 
little  more  intelligent  than  a  vegetable.  Its  soul  and  its 
intellect  are  there,  but  they  are  dormant,  waiting  to  be 
awakened.  It  has  also  little  control  over  its  body,  and 
all  its  movements  are  automatic  or  instinctive.  Probably 
there  is  not  a  single  expression  of  the  face  or  motion  of 
the  arms  or  legs  which  represents  a  distinctly  willed 
action.  Supported  in  the  arms,  the  child  cannot  hold 
its  head  upright,  but  lets  it  roll  from  side  to  side  as 
though  in  danger  of  snapping  it  off.  The  child  lies  just 
as  it  is  placed  in  bed,  unable  to  change  its  position.  A 
new-born  baby  probably  cannot  see  except  to  dis- 
tinguish light  from  darkness,  and  will  not  wink  when  the 
finger  is  brought  close  to  its  eyes.  It  seems  also  unable 
to  hear,  and  at  first  cannot  smell,  although  taste  is  well 
developed.  It  is,  in  fact,  not  directly  conscious  of  any- 
thing. When  it  nurses  at  the  breast  it  does  not  know  it 
is  nursing,  and  when  it  cries  it  is  ignorant  of  any  sensa- 
tion that  makes  it  cry.  Later,  when  it  moves  its  arms 
and  leg-s  strong^lv  during  nursing,  or  when  it  throws  its 
head  back  or  lifts  its  hand  in  response  to  a  forcible  touch- 
ing of  its  nose,  or  when  it  takes  hold  of  anything  placed 
ill  its  palm,  it  is  not  because  it  ivishes  to  express  eager- 


48  TIIF.    CARE    OF   THE   B.I  BY. 

iicss  for  aiiylhiiii:;'  to  eat,  or  to  move  its  head  out  of  the 
way  or  to  close  its  fingers,  but  siiiii)ly  because  it  cannot 
help  it. 

It  is  not  long,  however,  before  an  interesting  change 
begins.  There  is  seen  a  distinct  increase  in  the  ])ower 
of  control  over  the  members.  By  the  time  the  baby  is 
three  months  old,  or  sometimes  a  little  before  this,  it 
gradually  begins  to  make  efforts  at  grasping  after  objects, 
although  totally  unable  to  judge  whether  they  are  near 
or  far  away,  and  by  six  months  it  can  make  many 
well-directed  movements  and  will  play  with  toys.  Before 
the  age  of  two  months  the  baby  has  evidently  gained 
considerable  power  in  lifting  its  head,  and  by  that  of 
three  or  four  months  it  can  hold  it  without  support  very 
well.  It  usually  does  not  attempt  to  sit  up  until  it  is 
between  three  and  four  months  old,  and  does  not  succeed 
in  doing  so  unsupported  until  at  least  six  months  old. 
Even  then  it  is  not  very  steady,  and  is  easily  upset  until 
the  age  of  nine  or  ten  months. 

At  about  six  months  the  baby  will  sometimes  make 
an  eflfort  to  stand,  if  held  upright  on  its  feet  in  the 
mother's  lap,  and  will  try  to  put  one  foot  in  front  of  the 
other.  At  seven  or  eight  months  it  begins  to  creep  on 
its  hands  and  knees,  and  by  nine  or  ten  months  of  age  is 
often  able  to  stand  with  supjjort,  and  frequently  to  walk 
some  steps  by  holding  to  the  furniture  or  to  some  one's 
hand.  By  the  age  of  one  year  strong  children  can  walk 
a  little  without  help. 

There  is  no  absolute  rule,  however,  for  the  time  or  for 
the  exact  order  of  learning  to  creep  and  to  walk.  Many 
children  are  very  slow  in  walking,  particularly  if  they 
have  become  expert  and  rapid  crawlers,  while  some  do 
not  creep  at  all,  but  learn  first  to  stand  and  then  to  walk. 
Some  creep  only  on  the  hands  and  feet,  never  using  the 


THE    BABY'S   GROWTH.  49 

knees ;  others  never  creep,  but  progress  over  the  floor 
with  a  peculiar  pushing  movement  while  in  a  sitting 
position.  A  mother  should  be  in  no  hurry  about  the 
walking.  Fifteen  to  eighteen  months  is  really  quite 
early  enough,  and  some  children  do  not  learn  until  two 
years  of  age,  and  yet  are  perfectly  healthy.  Neverthe- 
less, as  great  a  delay  as  this  latter  cannot  but  lead  to  the 
suspicion  that  something  is  wrong  with  the  child's  devel- 
opment. 

It  is  a  curious  observation  that  when  babies  fall  during 
their  early  efforts  at  walking  they  nearly  always  go  back- 
ward into  a  sitting  position.  This  is  due  to  the  fact  that 
the  muscles  of  the  front  of  the  leg  have  not  yet  become 
as  strong  as  those  of  the  back.  Every  child  also  naturally 
walks  "pigeon-toed,"  and  the  learning  to  turn  the  toes 
out  is  always  a  slow  matter. 

With  the  increasing  power  and  control  of  motion  there 
is  a  development  of  the  senses  also.  By  the  age  of  six 
weeks  or  earlier  the  baby  can  fix  its  eyes  upon  objects 
near  it,  and  will  quickly  shut  them  if  something  is 
moved  rapidly  toward  them,  and  by  the  age  of  two 
months  its  vision  is  nearly  perfect,  although  colors  prob- 
ably cannot  be  distinguished  at  all  until  the  age  of  a 
year,  and  the  color-sense  even  after  this  increases  slowly 
in  many  children.  However,  although  able  to  see,  the 
infant  cannot  well  manage  the  motions  of  its  eyes  at  this 
period,  and  there  is  a  great  tendency  for  it  to  look  cross- 
eyed. Hearing  and  the  sense  of  smell  develop  rapidly, 
and  within  the  first  week  the  baby  will  be  awakened  by 
loud  noises.  It  does  not  begin,  however,  to  notice  the 
character  and  the  direction  of  sounds  until  it  is  three 
months  old.  Musical  tones  are  sometimes  recognized 
between  the  ages  of  one  and  two  years,  or  very  occasion- 
4 


50  THE    CARE    OF    THE   BABY. 

ally  earlier  than  this,  and  a  child  of  two  or  even  less 
may  distinctly  prefer  one  tune  to  another,  and  perhaps 
know  it  by  name.  In  other  instances,  however,  the 
power  to  recognize  a  tune  does  not  come  until  later 
childhood,  and  sometimes  never.  Things  are  made  up 
to  the  baby  later  in  life,  for  a  child  of  ten  years  both 
sees  and  hears  better  than  an  adult. 

It  would  be  interesting  to  know  what  a  baby's 
sensations  are  in  its  early  months  of  life,  but  we  can 
discover  this  only  to  a  limited  degree.  It  probably  feels 
pretty  comfortable,  on  the  whole,  and  when  uncom- 
fortable it  cries.  It  exjDeriences  hunger  and  the  inclina- 
tion to  sleep.  By  the  time  it  is  a  month  old  it  often 
shows  its  pleasnre  by  smiling,  but  it  generally  does  not 
really  laugh  until  five  or  six  months  of  age,  or  even 
older.  Smiles  before  the  age  of  one  month  are  usually 
not  indicative  of  pleasure,  but  belong  to  the  class  of 
automatic  and  similar  movements  referred  to. 

The  child  clearly  begins  to  have  more  intelligence,  and 
the  pleasure  that  accompanies  this,  when  it  is  three  months 
old,  and  by  this  time  shows  distinct  evidence  of  having  a 
mind  and  of  exercising  some  thought.  By  this  age  or  a 
little  later  it  learns  to  recognize  its  mother  and  to  be  pleased 
at  her  approach,  and  if  hungry  will  cease  crying  when  it 
sees  her  preparing  to  nurse  it.  It  also  enjoys  bright 
objects,  especially  if  they  are  moving  before  it.  Even 
before  the  age  of  three  months,  however,  it  seems  to 
appreciate  in  some  way  the  difference  in  the  handling 
of  it  by  different  persons,  and  is  soothed  by  some  and 
not  by  others.  Often,  too,  cr\ing  may  be  checked  by 
taking  the  child  up,  or  brought  on  by  laying  it  down, 
showing:  that  it  is  cosfuizant  in  some  wav  of  what  is  done 
to  it,  and  has  some  desires  in  the  matter.     Between  three 


THE   BABY'S   GROWTH.  51 

and  four  months  of  age  the  baby  begins  to  look  about  it 
more,  to  feel  the  pleasure  of  grasping  after  objects,  and  to 
show  fear  and  wonder.  When  it  is  four  or  five  months  old 
it  learns  to  recognize  other  friends  and  to  smile  and  move 
its  arms  at  them.  When  nine  months  old  it  will  give 
its  hand  when  requested,  and  will  thoroughly  enjoy  a 
game  of  "peep-bo."  By  the  completion  of  its  first 
year  it  has  learned  to  show  distinctly,  by  expressions 
of  face  and  by  gestures,  its  likes  and  dislikes  for  the  per- 
sons and  acts  of  others.  Between  the  age  of  one  and  two 
years  the  baby  shows  some  idea  of  number. 

All  sounds  made  early  in  life  are  impulsive  only. 
Although  the  child  at  one  or  two  months  of  age  begins 
to  use  its  voice  in  making  peculiar  cooing  noises  expres- 
sive of  comfort  and  happiness,  it  does  not,  of  course,  will 
to  utter  these  particular  sounds  rather  than  others.  About 
the  age  of  six  months  the  baby  commences  to  make 
different  vowel  sounds,  especially  that  of  aJi^  and  a  little 
later  it  learns  to  prefix  these  with  such  consonants  as 
;;/,  b^  d^  />,  ;/,  andy",  these  being  the  easiest  ones  to  pro- 
nounce. The  mother  often  now  firmly  believes  that  the 
baby  means  herself  when  it  makes  the  sound  of  ma-ma^ 
but  this  is  not  the  case.  The  child  is  only  expressing 
some  pleasurable  emotion  in  this  way. 

But  with  growing  mental  power  the  distinct  imitation 
of  sounds  soon  comes.  By  the  age  of  eight  or  ten  months 
the  child  utters  several  syllables  intelligently,  and  when 
it  is  a  year  old  it  can  say  "papa"  and  "mamma,"  and 
maybe  some  other  words,  and  really  means  what  it  says. 
Very  often  it  acquires  the  understanding  of  certain  words 
before  it  learns  to  speak  even  in  syllables.  At  eighteen 
months  of  age  it  can  express  many  of  its  desires  by  the 
use  of  a  few  words  aided  by  gestures,  and  by  two  years  it 


52  'I'llK  CARE   or  THE  />•//>•)'. 

can  speak  in  short  sentences,  althon.i,^li  its  vocabulary  is, 
of  course,  very  limited. 

We  can,  perhaps,  best  consider  here  the  growth  of  con- 
trol over  some  of  the  functions  of  the  body — namely,  the 
movements  of  the  bowels  and  the  passage  of  urine.  A 
great  deal  will  depend  upon  the  training,  but  all  children 
should  gain  complete  control  by  the  age  of  two  years  as 
an  extreme  limit,  and  most  of  them  acquire  it  long  before 
this,  and  need  a  diaper  only  during  the  night,  if  at  all. 
Some  who  have  been  carefully  taught  have  gained  almost 
complete  control  during  the  day  time  as  early  as  three 
months  of  age. 

We  have  yet  to  study  the  baby's  growth  in  bodily  pro- 
portions. There  have  been  very  many  estimates  made  of 
the  average  height  and  w^eight  of  children  at  different 
ages,  and  th3re  has  even  been  constructed  an  elab- 
orate algebraic  formula  for  calculating  what  these  should 
be.  The  truth  of  the  matter  is  that  the  variation  is 
too  considerable  to  allow  of  any  iron-bound  statements 
regarding  it.  The  table  here  given  (page  53)  is  an 
approximation  of  the  length  and  weight  which  chil- 
dren should  exhibit  from  birth  up  to  sixteen  years  of 
age. 

Looking  closely  at  the  table,  we  notice  several  inter- 
estinof  facts.  We  see  that  the  babv  usuallv  loses  weight 
during  the  first  week  and  often  longer,  but  that  by  the 
end  of  two  weeks  it  weighs  somewhat  more  than  at  birth. 
The  loss  of  weight  is  greater  than  the  table  shows,  for 
by  the  age  of  one  week  the  baby  has  regained  most  of 
the  loss.  As  a  rule,  a  child  loses  in  the  first  three  or 
four  days  about  one-fourteenth  of  its  initial  weight. 
To  this  rule  there  are  many  exceptions,  since  children 
sometimes  ^row  steadilv  heavier   from    the   bcijiuning. 


THE  BABY'S   GROWTH. 


53 


Tabi^e;  vSiiowiNci  Growth  in  IIfjght  and  Weight. 

AGE.  HKICiHT. 

Birth  19      in.        7 

1  week      7 

2  weeks 7 


WKIGHT. 

lbs.    9     oz. 

"    1%  " 

"       10%    "1 


1  month 

2  months 
3 

4 

5 

6 

7 
8 

9 

10 
II 

1  year 

2  years 
3 


9 
10 

I  r 

12 

13 
14 
15 
16 


20  Vi  m. 

21  " 


2Z% 

24 

24,'^ 

25 

25  K 

26 

26K 

27 

31 

35 

40 
43 
45 
47 
49 
51 
53 
55 
57 
59 
61 
6.:; 


8 

83^ 

lo44f 
12X 
131^ 
15 


1%    "     1 


16X 
I 

18X 
18^ 

19.3^ 
20!-2 
21 
27 

36 
40 

44 
48 

53 
58 
64 
70 

79 

88 
100 
109 
117 


>^   "     J    J 


Gained  i  oz.  a  da}^;  7  oz. 
a  week. 


J 


I  Gained   |4f  oz.  a  day;  5^ 
1         oz.  a  week. 

Double  original  weight. 
I  Gained   ^  oz.   a  day;  4^ 
I         oz.  a  week. 

.  .  Gained  Yz  inch  a  month. 
.  .  Gained  about  I  lb.  a  month. 

.  .  Treble  original  weight. 
.  .  Gained  4  inches  a  year. 

.  .  Double  original  length. 

j  Gained  3  inches  and  4  lbs. 

i         a  year. 

J  Gained  2  inches  and  4  lbs. 
'  1         a  year. 

I  Gained  2  inches  and  5  lbs. 

i         a  year. 

I  Gained  2  inches  and  6  lbs. 

i         a  year. 


I  Gained  2  inches  and  about 
\         9  lbs .  a  year. 


During  the  last  three  weeks  of  tlie  first  month  the  baby 
gains  about  one  ounce  a  day;  in  the  second  month  about 
one  ounce  a  day;  and  in  the  third  and  fourth  months 
abotit  five  ounces  a  week;  that  is,  about  three-quarters 


54  THE   CARE   OF  THE  BABY. 

of  an  ounce  a  day.  By  the  time  it  is  five  months  old  it 
has  doubled  its  original  weight.  In  the  fifth  and  sixth 
months  it  increases  two-thirds  of  an  ounce  a  day,  and 
after  this,  from  seven  to  twelve  months,  it  gains  at  the 
rate  of  about  one  pound  a  month — that  is,  three  and  two- 
thirds  ounces  a  week,  or  a  trifle  over  half  an  ounce  a  day 
— except  in  the  ninth,  and  again  in  the  eleventh  month, 
when  the  increase  in  weight  often  lessens  somewhat. 
At  the  age  of  a  year  the  baby  has  trebled  its  original 
weight. 

As  to  length,  we  are  struck  by  the  fact  that  from  the 
aee  of  two  to  that  of  four  months  the  increase  is  one 
inch  a  month,  and  after  this,  up  to  one  year,  it  is  half 
an  inch  a  month. 

After  the  first  year  we  notice  that,  taking  it  all  together, 
there  is  a  gradual  increase  in  the  number  of  pounds  and 
a  decrease  in  the  number  of  inches  added  yearly,  four 
inches  being  gained  in  both  the  second  and  third  years, 
three  inches  in  the  fourth  and  fifth  jears,  and  after  this 
two  inches  a  year.  The  gain  in  weight  is  four  pounds 
yearly  from  the  age  of  three  to  that  of  seven  years,  then 
five,  then  six,  and  then  about  nine  pounds.  It  sometimes 
happens  that  at  about  the  age  of  nine  in  girls  and  eleven 
in  boys  there  is  almost  a  cessation  of  growth  for  a  short 
time.  Later,  at  about  twelve  years,  girls  take  on  a  par- 
ticularly rapid  growth,  and  decidedly  exceed  boys  of  the 
same  age  in  weight,  and  sometimes  in  height  also. 
At  fifteen  or  sixteen  years  the  rapidity  of  growth  in 
girls,  both  in  weight  and  height,  will  be  greatly  dimin- 
ished, while  boys  of  this  age  will  often  begin  to  de- 
velop very  rapidly,  and  will  soon  materially  exceed  the 
other  sex  in  both  respects.  These  times  for  the  re- 
tardation and  acceleration  of  growth  varv  greatlv,  how- 


INFANT'S  WEIGHT  CHART. 


SICHBD  BV  J.  P.  CROZER  GRIFFITH,  i 


Months.  1  2 

Weeks.  1     3   U     '    P 


'0      11      IS   13   14   15   10   17   18   19   20   21   22 


37  29  |31  33  J5  37  SS  41  43   45  47 


"^ 


:^i 


29  31  33  36  37  39  41  43 


THE   BABY'S   GROWTH.  55 

ever,    in  different  children.      No  fixed  rule  can  be  for- 
mulated. 

The  weights  and  measurements  in  the  table  apply 
fairly  well  to  children  of  both  sexes,  although  it  is  a  fact 
that  boys  at  birth  are  apt  to  be  somewhat  larger  and 
heavier  than  girls,  and  to  continue  so  until  the  neighbor- 
hood of  twelve  years.  In  fact,  all  the  figures  in  the  table 
are,  of  course,  only  average  ones,  and  a  child  may  meas- 
ure or  weigh  somewhat  less  without  there  being  any 
occasion  for  anxiety  if  it  is  perfectly  healthy;  while  it 
may  decidedly  exceed  the  figures  without  being  phenom- 
enal. This  is  especially  true  of  children  who  have 
passed  the  age  of  three  or  four  years.  We  all  know  how 
great  the  variations  in  size  are  in  early  and  later  child- 
hood. When,  however,  it  is  an  infant  which  is  materially 
behind  in  its  height  or  weight,  the  mother  should  at 
least  have  her  suspicion  aroused  that  something  is  wrong. 
A  useful  and  convenient  plan  of  recording  the  weight 
during  the  first  two  years  is  upon  a  "Weight  Chart,"  ^ 
such  as  the  sample  copy  opposite.  This  is  rather  more 
accurate  than  the  table.  The  figures  at  the  top  and  bot- 
tom give  the  weeks  and  months  of  the  age;  those  at 
the  sides  the  pounds  and  ounces;  each  horizontal  line 
representing  four  ounces.  The  line  running  diagonally 
across  the  chart  represents  the  norm,al  weight  of  an  aver- 
age breast-fed  baby.  In  using  the  chart  the  baby  should 
be  weighed  weekly,  a  dot  with  ink  made  on  or  between 
the  horizontal  lines  to  correspond  with  the  weight  ob- 
tained, and  these  dots  as  made  joined  by  an  ink  line. 

This  weekly  weighing  of  the  baby  is  exceedingly  im- 
portant in  order  to  be  sure  that  growth  is  going  on  prop- 

^  These  can  be  obtained  from  the  publishers  of  this  book  at  a  cost  of  50 
cents  for  a  block  of  twenty-five  charts. 


56  THE    CARE    OF   THE   BABY. 

erly.  But  to  obtain  results  at  all  accurate  it  is  very  im- 
portant that  the  baby  be  weighed  without  clothes,  or, 
better  still,  that  it  be  weighed  when  dressed,  and  that 
the  weight  of  the  clothes  or  of  a  similar  suit  be  ascer- 
tained afterward  and  the  amount  deducted.  It  will  not, 
cf  course,  be  necessary  to  weigh  the  clothes  separately 
on  every  occasion  if  we  are  careful  that  they  are  always 
of  the  same  sort.  Systematic  weighing  is  particularly 
important  when  some  change  in  diet  is  being  made,  for 


Fig.  6. — The  "Favorite"  family  scales. 

we  can  determine  in  this  way  whether  the  food  is  suf- 
ficiently nourishing  in  quality  or  great  enough  in  quan- 
tity. Either  accurate  spring  scales  or  steelyards  serve 
fairly  well  to  do  the  weighing.  A  very  convenient 
form,  called  the  "Favorite"'  baby  scales,  consists  of  a 
strong  standing  spring  scales  with  a  basket  firmly  at- 

'  The  "Favorite"  baby  scales  retails  at  about  $5.00,  and  the  "Favorite" 
family  scales  at  $2.00.  Both  are  made  by  John  Chatillon  &  Sons,  New  York. 
The  "Counter"  scales  are  made  by  E.  &  T.  Fairbanks  &  Co.,  and  retail  at 
between  ^7.00  and  $8.00. 


THE  BA BY'S    GK O  IVTIl. 


57 


tached.  Another  less  expensive  scales  of  the  same  gen- 
eral form,  and  made  by  the  same  firm,  is  shown  in  the 
illustration  (Fig.  6).  A  scoop  takes  the  place  of  the 
basket.  With  these  spring  scales  the  results  are  not 
quite  so  accurate  as  with  balance  scales  in  which  weights 
are  used  (Fig.  7).  With  either  form  the  scoop  may  be 
removed,  if  found  too  small  as  the  baby  grows,  and  a 
flat  board  attached  in  place  of  it,  balancing  this  properly 
to  allow  for  the  difference  in  weight.  Whatever  appa- 
ratus is  employed  must  show  variations  in  weight  down 


Fig.  7. — "Counter"  scales. 


to  one  ounce.  Those  having  markings  of  only  a  quarter 
of  a  pound  or  more  are  useless  for  our  purpose.  In  using 
the  steelyard  the  child  is  pinned  securely  in  a  towel  or 
opened  diaper,  and  this  then  hung  on  the  hook.  In 
weighing  children  of  five  years  and  older  the  clothes 
may  be  assumed  roughly  to  be  one-twelfth  of  the  total 
weight  of  the  child  when  dressed. 

To  measure  the  length,  the  baby  may  be  held  against 
the  wall  with  its  feet  resting  upon  the  floor,  and  the 


58 

PI 


Fig.  8. — Appa- 
ratus for  measur- 
ing an  infant's 
lentith. 


THE   CARE    or   THE  BABY. 

height  be  marked  above  it.  A  much  more 
convenient  and  correct  method  is  to  have  a 
carpenter  construct  an  apparatus  like  an 
enlarged  foot-measure  of  the  kind  em- 
ployed by  shoemakers.  This  is  used  when 
the  child  is  lying  on  a  firm  bed,  the  end- 
piece  being  placed  above  its  head  and  the 
sliding  one  moved  along  until  the  feet  (both 
toes  and  heels)  rest  upon  it.  The  apparatus 
shown  in  the  illustration  (Fig.  8)  is  forty-six 
inches  long,  and  the  upright  pieces  are  eight 
inches  in  length  and  are  lined  with  felt 

As  the  baby  grows,  not  only  is  there  an 
increase  in  the  total  weight  and  height, 
but  the  relative  value  which  the  dimen- 
sions of  the  various  parts  of  the  body  bear 
to  each  other  also  changes,  since  one  part 
grows  more  rapidl}'  than  another.  This  is 
well  shown  by  the  accompanying  illustra- 
tion, taken  from  an  article  by  Dr.  L.  IM. 
Yale^  (Fig-  9)-  The  six  figures  represent 
the  ages  of  one,  five,  nine,  thirteen,  seven- 
teen, and  twenty-two  years;  that  is,  they  are 
separated  by  periods  of  four  years  each. 
Each  figure  is  divided  into  four  equal  parts, 
marked  by  the  crossing  of  the  dotted  lines. 
The  lines  are  curved,  simply  because  the 
child  grows  more  and  more  slowly.  If  its 
length  kept  increasing  at  the  same  rate  all 
the  time,  it  is  obvious  that  the  lines  would 
be  straight.  If  we  look  again  at  the  dia- 
gram, we  see  that  the  head  of  the  child  of 
one  year  measures  one-fourth  of  its  total 

'  Bobyhood,  vol.  ii.  p.  311. 


The   BABY'S   CROWTIl. 


59 


length,  while  the  trunk  is  not  nuicli  more  than  this,  and 
the  legs  do  not  measure  more  than  one  and  one-half 
fourths   (three-eighths).      As  the  author  says,  the  child 


15  ©  13  17  21 

Fig.  g,-:— Diagram  showing  proportionate  growth  of  different  parts  of  the  body  at 
various  ages  from  i  to  2i  years. 

is  "four  heads  high."  In  the  adult  of  twenty-one 
years  we  see  that  the  head  is  proportionately  much 
smaller,  measuring  only  two-thirteenths  or  less  of  the 
whole  length,  while  the  legs  have  grown  much  more 
rapidly  and  now  equal  one-half  of  the  total  length.  The 
trunk  has  not  kept  pace  with  the  legs,  for  in  the  baby 
the  middle  of  the  body,  as  shown  by  the  dotted  line,  is 
the  navel,  while  in  the  adult  it  is  decidedly  lower.  All 
this  rapid  growth  of  the  legs  is  generally  accomplished 
after  the  age  of  nine  years,  as  the  diagram  shows.  It  is 
well  known  how  rapidly  boys  and  girls  shoot  up  after 
this  period,  and  how  out  of  all  proportion  their  appa- 
rently long  legs  seem.  The  legs  are,  in  fact,  really  no 
longer  than  they  ought  to  be,  but  we  have  grown  so 
accustomed  to  the  short  legs  of  earlier  years  that  the 
change  does  not  seem  natural. 


6o  THE   CARE    OF   THE  BABY. 

At  the  age  of  thirteen  or  fourteen  years,  the  time  of 
puberty,  a  decided  change  takes  place  in  girls,  the  figure 
beginning  to  assume  that  of  womanhood,  and  the  men- 
strual discharge  appearing;  while  at  about  the  same  time 
or  a  little  later  boys  experience  a  change  of  voice. 

Besides  the  growth  in  height  and  weight,  there  is,  of 
course,  increase  in  girth  as  well.  The  matter  of  most 
importance  here  is  the  circumference  of  the  head  and 
that  of  the  chest.  We  should  know  what  these  ought  to 
be  at  different  ages,  for  the  proper  increase  of  girth  of 
chest  is  an  indication  of  proper  development,  and  varia- 
tions from  the  normal  size  of  the  head  may  indicate  dis- 
ease. It  is  important,  however,  to  remember  that  the 
heads  of  different  babies  vary  much  in  shape  and  size 
within  normal  limits.  The  chest-measure  should  be 
taken  just  above  the  nipples,  and  that  of  the  head  at  a 
little  above  the  level  of  the  eyebrows.  The  following 
table  shows  approximately  the  circumferences  of  the  chest 
and  of  the  head  at  different  periods  of  life: 

Table  Showing  Circumferences  of  Head  and  Chest  at 
Different  Ages. 

HEAD.  CHEST. 

Birth ly/z  inches.  13      inches. 

6  months 17  "  16;^ 

1  year  iS  "  17)2 

2  years  i8>^       "  18 

3  "  19  "  20 

5         "  20>^  "  22 

Adult  life 21^2       "  30+ 

It  is  interesting^  to  observe  from  this  table  how  much 
more  rapidly  the  chest  grows  than  the  head. 

In  this  connection  we  must  not  forget  the  condition  of 
the  anterior  fontanelle.  This  opening  grows  no  smaller, 
and  even  increases  in  size  up  to  the  age  of  nine  months. 


THE   BABY'S   GROWIH.  6l 

After  this  it  grows  steadily  smaller  by  the  growth  of  bone 
over  it,  and  should  be  entirely  closed  in  healthy  children 
by  the  age  of  seventeen  or  eighteen  months. 

Finally,  we  must  consider  some  of  the  new  acquisitions 
of  the  child  in  the  line  of  development.  Among  these  is 
the  ability  to  shed  tears,  which  has  already  been  referred 
to.  A  new-born  baby  can  cry  and  its  eyes  become 
moist,  but  it  is  generally  not  until  the  age  of  three  or 
four  months  that  tears  actually  run  down  its  face. 

Another  acquirement  is  the  new  head  of  hair  which  fol- 
lows the  first  one.  At  about  the  end  of  the  first  week  the 
first  hair  often  begins  to  fall  out,  and  continues  to  do  so 
for  one  or  two  weeks.  A  considerable  amount  of  it  also 
is  worn  away  from  the  back  of  the  head  by  friction 
upon  the  pillow.  The  new  hair  begins  to  grow  in  only 
very  slowly,  and  is  of  the  same  soft,  silky  texture  as  the 
first,  but  lighter  in  color  than  it  was,  or  than  the  hair 
will  be  in  adult  life.  Indeed,  throughout  the  child's  life, 
leaving  the  first  hair  out  of  account,  there  is  a  tendency 
for  the  color  to  grow  constantly  darker.  The  speed  with 
which  the  hair  grows  in  is  very  variable.  One  may  some- 
times see  a  child  of  five  months  with  its  head  actually 
shaggy,  but  as  a  rule  it  is  very  thinly  covered  at  this  age 
and  for  months  after  it.  Sometimes  children  are  born 
with  remarkably  shaggy  heads  of  hair  and  do  not  suffer 
this  early  loss  of  it. 

Then,  too,  the  baby  acquires  increased  powers  of  diges- 
tion not  possessed  before.  Saliva  is  one  of  the  secretions 
of  value  in  the  digestion  of  starch.  In  early  life  it  is 
only  sufficient  in  amount  to  keep  the  mouth  moist,  but 
at  the  age  of  three  or  four  months  it  has  increased  so 
greatly  that  the  baby  begins  to  dribble  and  must  have  its 
clothing  protected  by  a  bib.  ]\Iany  people  suppose  that 
this  dribbling  is  a  sign  of  irritation  produced  by  the  cut- 


62  THE    CARE    OF   THE   BABY. 

ting  of    teeth,    but,    although    it    usually   accompanies 

teething,  it  is  really  only  the  evidence  of  the  acquisition 
by  the  child  of  the  new  secretion.  Indeed,  there  is  no 
excessive  production  of  saliva  at  the  time  the  teeth  which 
one  would  suppose  were  the  hardest  to  cut — namely,  the 
molars — come  througli  the  gums.  There  is  certainly  no 
intimate  connection  between  healthy  dentition  and  the 
flow  of  saliva. 

So,  too,  the  secretion  of  the  stomach,  generally  called 
the  gastric  juice,  is  poorly  developed  in  young  babies, 
and  the  digestive  strength  of  the  juices  of  the  pancreas 
and  of  the  intestine  is  also  very  weak  ;  but  all  these 
increase  with  advancing  age.  On  the  other  hand,  the 
movements  of  the  stomach  are  remarkably  active  in 
babies,  and  we  consequently  often  see  regurgitation  of 
food  occurring  daily. 

Finally,  we  have  the  acquisition  which  is  the  cause  of 
the  greatest  excitement  and  pleasure  to  the  family  at  first, 
and  often  of  much  worry  later — the  teeth.  At  the  very 
outset  we  must  bear  in  mind  that  teething  is  a  normal 
process  and  not  a  disease.  We  are  making  a  woful  mis- 
take if  we  attribute  to  teething  disturbances  of  the  baby 
which  are  caused  by  some  real  ailment.  INIany  and  many 
a  mother  has  allowed  a  child  to  suffer,  and  even  to  die, 
because  she  has  supposed  that  the  evident  distress  was 
the  result  of  an  advancing  tooth.  It  is  one  of  the  com- 
monest things  in  the  world  for  a  tooth  to  be  cut  without 
anyone  knowing  that  anything  is  happening.  It  is  never 
right  for  a  mother  to  take  it  for  granted  that  the  teeth 
are  the  source  of  fretfulness,  but  a  thorough  search  must 
be  made  for  some  more  remote  cause.  Physicians  sel- 
dom practise  gum-lancing  nowadays,  as  compared  with 
the  frequency  of  a  few  years  ago.  There  is,  however, 
such  a  thing  as  disordered  dentition,  but  this  can  be 
better  considered  among  the  diseases  of  infancy. 


THE   BABY'S    GROWril.  63 

A  baby  at  birth  possesses  smooth,  firm  gums,  of  a  light- 
pink  color,  with  quite  narrow  and  rather  sharp  and  hard 
edges.  After  some  months,  as  the  teeth  begin  to  ap- 
proach the  surface,  the  edges  of  the  gums  grow  broader 
on  the  anterior  aspect  and  somewhat  more  prominent, 
but  do  not  become  red  or  inflamed  in  ordinary  healthy 
teething.  This  condition  may  continue  for  a  month  or 
more  before  any  teeth  are  cut.  The  teeth  have  a  definite 
order  of  appearing;  and  yet  this  is  subject  to  very  great 
variation,  and  writers  differ  somewhat  as  to  just  what  the 
normal  order  is.  There  are  twenty  milk  teeth — tempo- 
rary or  deciduous  teeth,   as   they   are   also   called — and 

their  eruption  constitutes  the 
first  dentition.  They  consist,  in 
each  jaw,  of  two  central  incis- 
ors, two  lateral  incisors,  two 
canines,  two  anterior  molars, 
\;'^^^?r;>  '''-y-'W/ii'*     ^^^^  ^^'-*  posterior  molars.  Their 

Fig.  lo.-Diasram  showin-'the    arrangement  may  be  seen  in  the 

temporary    teeth :     a,   central    in-     diagram  (Fig.  lo).       The  Cauiue 

cisors ;    b,  lateral  incisors;    c,  ca-  -    ,  . 

nines;  d,  anterior  molars;   e,  pos-     tCCtll  of  the  Upper  J aW  are  COm- 

terior  molars.  mouly  Called  the  eye  teeth,  and 

those  of  the  lower  jaw  the  stomach  teeth. 

The  permanent  teeth,  or  the  teeth  of  the  second 
dentition,  number  thirty-two.  They  begin  to  appear 
about  the  sixth  year  of  life,  and  consist  of  four  incisors, 
two  canines,  four  bicuspids,  and  six  molars  in  each  jaw 
(Fig.  11).  In  this  dentition  the  incisors  and  canines 
replace  those  of  the  first  dentition,  the  bicuspids 
take  the  place  of  the  temporary  molars,  and  the  perma- 
nent molars  appear  where  there  were  no  teeth  at  all 
before. 

The  teeth  are  cut  in  distinct  groups,  with  a  pause  be- 
tween the  eruption  of  each  group.     The  first  group  of  the 


64 


THE    CAKE    OE   THE   BABY. 


milk  teeth  to  appear  usually  consists  of  the  lower  cen- 
tral incisors,  which  come  through  the  gum  at  about 
the  age  of  seven  months,  although  often  earlier  than 
this.  Then  occurs  a  pause  of  three  to  eight  w'eeks,  fol- 
lowed by  the  appearance  of  the  second  group,  consist- 
ing of  the  four  upper  incisors,  between  the  age  of 
eight  and  ten  months.  The  central  upper  incisors  gen- 
erally appear  first,  followed  closely  by  the  lateral  upper 
incisors.  A  second  pause  now  occurs,  lasting  from  one 
to  three  weeks,   followed   by  the   eruption  of  the   third 


Fig.  II. — Diagram  showing  the  permanent  teeth:  a,  central  incisors;  b, 
lateral  incisors;  c,  canines;  d,  first  bicuspids;  e,  second  bicuspids;  f,  first 
molars ;   g,  second   molars ;    //,  third   molars. 

group  of  teeth — namely,  the  four  anterior  molars  and  the 
two  lower  lateral  incisors — which  appear  at  the  age  of 
from  twelve  to  fifteen  months.  The  teeth  of  the  third 
group  are  not  all  cut  at  once  or  in  any  invariable  order, 
although  the  anterior  molars  in  the  upper  jaw  often  come 
first,  and  are  followed  by  the  incisors  and  then  by  the 
molars  of  the  lower  jaw.  After  the  third  group  there 
comes  a  pause  of  two  or  three  months,  no  more  teeth  ap- 
pearing until  the  age  of  eighteen  months,  at  which  time, 
or  between  the  ages  of  eighteen  and  twentv-four  months, 
the  fourth  group,   the  canines,   are  cut.       Finally,  after 


THE   BABY'S   GROWTH.  65 

another  pause  of  two  to  four  months,  the  fifth  group, 
the  posterior  molars,  appear,  between  the  twentieth  and 
thirtieth  months  of  life.  Thus  it  will  be  seen  that  a 
baby  a  year  old  should  have  at  least  six  teeth,  and  pos- 
sibly twelve,  if  the  third  group  is  cut  promptly,  and  that 
by  the  time  it  is  two  or  two  and  one-half  years  of  age  all 
the  temporary  teeth  should  be  through.  The  following 
tabular  arrangement  shows  at  a  glance  the  order  and 
time  of  the  eruption  of  the  temporary  teeth: 

Eruption  op  Milk  Teeth. 

First  group  .   .      Two  lower  central  incisors.  .   .  7  months. 

Pause   .    .    .    .  3  to  8  weeks. 
Second  group  .    .  Four  upper  incisors 8  to  10        " 

Pause   .   .   .    .  I  to  3  months. 
Third  group    .    .  Four  anterior  molars  and  two 

lower  lateral  incisors    ....  12  to  15        " 

Pause   .    .    .    .  2  to  3  months. 
Fourth  group  .    .  Four  canines 18  to  24        " 

Pause   .    .    .    .2  to  4  months. 
Fifth  group      .    .  Four  posterior  molars     ....  20  to  30        " 

As  has  already  been  stated,  a  great  deal  of  variation  is 
seen  both  in  the  order  and  in  the  time  of  the  cutting  of 
the  milk  teeth,  and  the  mother  need  not  think  it  strange 
if  the  two  lower  central  incisors  are  not  the  first  to 
appear.  So,  too,  a  healthy  baby  may  cut  its  first  tooth 
at  decidedly  less  than  four  months  of  age,  or  may  even 
be  born  with  an  incisor  tooth  ;  or,  on  the  other  hand, 
may  still  be  toothless  at  the  age  of  eight  or  nine  months. 
Instances  of  children  born  with  teeth  are  uncommon. 
Such  a  tooth  generally  soon  falls  out  and  is  replaced  at 
the  proper  age  by  a  regular  milk  tooth.  Sometimes, 
however,  it  remains  until  supplanted  by  one  of  the 
second  dentition.  It  is  at  times  necessary  to  remove 
these  premature  teeth,  but  the  decision  upon  this  point 
will  naturally  be  left  to  the  child's  physician. 

R 


66  THE    CARE    OE   THE   BABY. 

Too  great  a  delay  in  the  beginning  of  dentition  is  a 
sign  of  ill-health,  and  a  baby  who  has  no  teeth  by  the 
age  of  a  year  cannot  be  considered  to  be  in  a  healthy 
state,  however  plnnip  and  well  nourished  it  may  be. 
Just  what  ails  it  we  shall  consider  in  the  chapter  treat- 
ing of  the  Sick  Baby. 

The  milk  teeth  stay  in  position  for  several  years. 
Then,  as  the  permanent  teeth  push  forward  in  the  jaw 
beneath  them,  their  roots  become  partially  or  entirely 
absorbed,  and  the  teeth  themselves  loosen  and  fall  out,  or 
are  pushed  out  by  the  advancing  permanent  teeth,  in 
much  the  same  order  as  that  in  which  they  came  in. 
Very  often  they  do  not  fall  out  as  soon  as  they  should, 
and,  as  a  result,  the  incoming  second  teeth  are  crowded 
out  of  position,  and  a  very  ugly  displacement  is  finally 
produced,  which  is  wholly  the  result  of  negligence  on 
the  part  of  the  mother.  A  child  should  be  taken  to  the 
dentist  at  regular  intervals,  whether  or  not  the  teeth  are 
decayed,  in  order  that  no  such  disfigurement  may  arise; 
for  it  is  much  easier  to  prevent  it  than  it  is  to  correct  it 
when  once  present.  The  narrowness  of  the  jaw  in  a  child 
is  another  reason  why  the  permanent  teeth,  particularly  the 
canines,  are  so  often  displaced  forward  and  outward,  and  this 
fact  renders  the  advice  of  a  dentist  still  more  important. 

The  earliest  of  the  permanent  set  to  appear  are  the 
first  anterior  molars,  often  called  the  "six-year-old  teeth," 
which  come  in  immediately  adjoining  and  to  the  outside 
of  the  temporary  second  molars.  A  mother  should  be  on 
the  watch  for  these  teeth,  for,  as  they  do  not  replace  any 
of  the  teeth  already  present,  they  are  apt  to  be  cut,  and 
even  to  decay,  without  her  being  aware  of  it.  The  re- 
maining permanent  teeth  are  cut  in  much  the  same  order 
as  the  milk  teeth.  The  order  and  the  date  of  appearing 
are  shown  in  the  following  table  : 


THE   BABY'S   GROWTH.  6j 

Eruption  of  Permanent  Teeth. 

Four  first  molars 6  years. 

Four  central  incisors 7  " 

Four  lateral  incisors 8  " 

Four  first  bicuspids 9  to  10  " 

Four  second  bicuspids 10  to  11  " 

Four  canines 11  to  13  " 

Four  second  molars 12  to  15  " 

Four  third  molars 17  to  25  " 

The  teeth  of  the  lower  jaw  are  cut  somewhat  before 
the  corresponding  ones  of  the  upper  jaw,  the  intervals 
being,  perhaps,  as  great  as  several  mouths.  The  time 
of  the  eruption  of  the  permanent  teeth  varies  consider- 
ably within  certain  limits.  The  third  molars  are  popu- 
larly termed  the  "wisdom  teeth."  Their  eruption  is 
frequently  delayed  until  considerably  after  the  age  of 
twenty-five  years. 

The  alterations  in  pulse  and  respiration  and  in  the  fre- 
quency of  the  bowel-movements  and  of  the  passage  of 
urine  which  take  place  with  increasing  age,  as  well  as 
some  of  the  minor  changes  of  the  first  few  weeks,  have 
already  been  referred  to  at  length  in  the  preceding  chap- 
ter. This  was  done  as  a  matter  of  convenience  merely, 
for  the  changes  are  connected  closely  with  the  baby's 
growth,  and  belong  properly  to  the  subject  of  the  present 
chapter. 

Finally,  let  no  mother  conclude  offhand  that  the  statis- 
tics which  have  been  given  are  incorrect  because  they  do 
not  accord  with  her  experience  in  the  case  of  her  own 
children.  They  are  average  only,  and  are  the  result  of 
much  and  careful  study  by  different  observers.  Of  course, 
some  children  are  much  ahead  of  the  average,  and  others 
behind  it,  yet  the}^  are  nevertheless  neither  remarkable 
nor  unhealthy. 


68 


THE    CARE    OF   THE   BABY. 


CHAPTER    IV. 

THE  BABY'S  TOILET. 

All  this  time,  although  we  have  been  watching  the 
baby  grow,  we  have  not  seen  it  either  bathed  or  dressed. 
In  preparation  for  the  first  and  for  subsequent  toilets  it  is 
customary,  before  the  baby's  birth,  to  get  ready  that  most 


Fig.  1 2. — Baby's  basket. 

convenient  article  commonly  known  as  flic  baby^'s  bas- 
ket. A  large  selection  of  baskets  may  be  found  in  the 
shops,  fitted  in  different  ways  to  suit  the  varying  fancies 
and  means  of  mothers.  In  choosing  one  it  is  to  be 
remembered  that  too  elaborate  a  basket  is  more  orna- 
mental than  useful.      A  serviceable  form  is  a  stand  of 


THE  BABY'S    TOILET. 


69 


wicker,  the  lower  part  of  which  consists  of  one  or  more 
shelves  or  of  a  closed  basket  where  articles  of  clothing 
not  immediately  needed  can  be  kept;  while  the  upper 
portion,  or  baby's  basket  proper,  consists  of  an  oval  or 
oblong,  rather  shallow  receptacle  which  may  or  may  not 
be  provided  with  a  lid  (Fig.  12).  It  is  important  that 
the  stand  be  low,  as  otherwise  the  articles  contained  can- 


FiG.  13. — Baby's  basket,  hamper  form. 

not  well  be  reached  from  the  chair  used  when  making 
the  child's  toilet.  The  chair  is  also  low  in  order  that  it 
may  make  the  nurse's  knees  high  enough  to  form  a  good 
lap.  The  basket  should  possess  several  pockets  around 
the  inside,  to  hold  the  smaller  articles.  It  should  also 
have  one  or  two  pin-cushious  fastened  within  it.  The 
interior  may  be  lined  with  silk  or  cambric,  according  to 
taste,  and  the  basket  draped  with  lace  or  Swiss  muslin. 
A  simpler  and  very  popular  kind  of  basket,  more  easily 


yo  THE    CARE    OF   THE   BABY. 

moved  about,  is  one  of  the  hamper  form  with  a  hinged 
lid.  This  is,  of  course,  not  provided  with  a  stand.  The 
lower  part  of  the  hamper  contains  clothing,  while  a  tray 
above  this  holds  the  various  articles  for  immediate  use 

(Fig-   13)- 

The  baby's  basket  should  contain  the  following 
articles: 

Salicylated  cotton  for  dressing  the  cord. 
Plain  absorbent  cotton  for  washing  the  mouth,  eyes, 
and  navel. 

Blunt-pointed  scissors. 

Safety-pins  of  assorted  sizes. 

A  soft  baby's-hair-brush. 

A  small,  fine  comb. 

A  powder-box  containing  powder  and  puff. 

Soap  in  a  metal  or  celluloid  soap-box. 

A  fine,  soft  sponge  and  a  soft  wash-rag. 

Vaselin  in  a  jar  or  tube. 

An  old  soft  blanket  in  which  to  receive  the  child  after 

birth. 
A  couple  of  soft  towels. 
A  woollen  shawl  or  shoulder-blanket. 
A  complete  suit  of  clothes. 

The  choice  of  the  soap,  powder,  hair-brush,  etc.  will 
be  considered  presently,  and  the  nature  of  the  clothes 
will  be  discussed  in  the  next  chapter. 

The  first  washing  of  the  baby  is  the  business  of  the 
monthly  nurse,  and  the  mother  has  no  share  in  it.  Still, 
it  is  well  for  her  to  understand  how  it  should  be  done,  if 
only  as  a  matter  of  interest.  We  must  remember  that 
the  new-born  baby  is  a  very  tender  object,  exceed- 
ingly susceptible  to  the  influence  of  cold,  and  with  a  very 
delicate  skin.  Indeed,  in  the  case  of  children  weakly  at 
birth  the  physician  often  forbids  any  washing  whatever 


THE  BABY'S    TOILET.  7 1 

until  the  vitality  has  increased.  In  giving  a  bath  it  is 
consequently  necessary  to  guard  most  carefully  against 
draughts.  The  doors  and  windows  must  be  closed,  and 
the  child  should  be  protected  still  further  by  placing  a 
folding  screen  around  the  nurse's  chair  and  the  tub,  and 
by  doing  the  bathing  before  a  fire  unless  the  weather  be 
very  hot. 

The  washing  and  drying  should  be  done  thoroughly, 
rapidly,  and  yet  with  the  greatest  gentleness.  The  nurse 
seats  herself  in  her  low  chair  beside  the  tub,  with  the 
baby's  basket  and  the  vessels  of  hot  and  cold  water  con- 
veniently at  hand.  She  should  protect  herself  with  a 
rubber  apron,  over  which  is  a  second  bath-apron  of 
warmed  soft  flannel  on  which  the  baby  lies.  A  very  con- 
venient form  which  has  been  recommended  consists  of 
two  long  and  broad  pieces  of  flannel  or  other  soft  mate- 
rial sewed  or,  better,  buttoned  to  the  same  waistband. 
The  lower  one  of  these  may  be  used  to  hold  the  baby  in, 
and  the  upper  one  to  cover  it  after  its  daily  bath  and 
while  it  is  being  dried  with  the  towels  ;  or  the  upper  one 
may  hold  the  baby  while  being  dried,  after  which  it  may 
be  unbuttoned  and  cast  aside,  and  the  lower,  dry  apron 
may  be  used  to  hold  the  child  while  being  dressed.  At 
the  first  washing  the  old  blanket  contained  in  the  baby's 
basket  should  be  used  to  wrap  the  child  in  immediately 
after  birth  and  until  it  has  been  oiled,  soaped,  and  dipped. 

The  new-born  baby  is  more  or  less  covered  with  a 
whitish,  waxy  substance  which  must  be  removed  en- 
tirely, especially  from  all  folds  and  hollows  of  the  body, 
such  as  the  armpits,  hollows  of  the  knees,  groins,  and 
ears,  as  otherwise  irritation  of  the  skin  is  apt  to  be 
set  up.  As  the  cleansing  is  not  easily  accomplished  by 
ordinary  washing,  it  is  necessary  first  to  rub  the  skin  all 
over  with  olive  oil  or  with  purified  white  vaseline.     This 


72  THE   CARE    OE  THE  BABY. 

is  much  better  than  lard  unless  the  latter  has  been  care- 
fully freed  from  salt  by  washing.  The  baby  should  now 
be  laid  on  its  back  and  be  enveloped  in  the  old  blanket, 
and  should  then  have  its  face  carefully  washed  with 
warm  water  and  a  very  soft  sponge  or  wash-rag,  but 
without  soap.  The  eyes  must  receive  particular  atten- 
tion. The  lids  should  be  separated  by  the  fingers  and 
gently  and  thoroughly  freed  from  all  secretions  by  squeez- 
ing a  little  warm  water  between  them  and  very  gently 
rubbing  them  with  a  little  moistened  absorbent  cotton. 
This  care  is  needed,  because  in  the  process  of  birth  irri- 
tating substances  often  enter  the  eyes  and  set  up  a  severe 
inflammation  which  may  even  terminate  in  loss  of  sight. 
Sometimes  the  physician  in  charge  himself  washes  the 
eyes,  or  orders  them  to  be  washed  with  some  strong  anti- 
septic solution  if  he  deems  it  necessary,  but  such  solu- 
tions should  never  be  used  without  his  orders. 

The  mouth  must  now  be  cleansed  very  carefully  with 
a  little  absorbent  cotton  wrapped  around  the  nurse's 
finsfcr.  Indeed,  it  is  often  necessary  to  wash  the  mouth 
instantly  after  birth  if  much  mucus  or  other  material  has 
been  forced  into  it. 

The  bath  may  now  be  prepared,  the  water  being  at  a 
temperature  of  ioo°  F.  as  shown  by  the  thermometer, 
not  as  guessed  at  by  the  nurse.  The  whole  body  except 
the  face,  which  has  already  been  washed,  is  now  rubbed 
with  soap  and  water.  The  soap  is  best  applied  with 
a  wash-rag,  which  adapts  itself  to  the  folds  and  creases 
rather  better  than  a  sponge  does.  The  baby  is  then 
placed  in  its  tub  and  entirely  submerged  except  the 
head.  It  may  be  kept  in  the  bath  for  a  minute  or  two 
if  it  seems  to  enjoy  it.  While  there  its  head  and 
back  are  supported  by  the  nurse's  left  arm  and  wrist,  her 
hand  grasping  its  left  shoulder,  and  thus  keeping  it  from 
slipping  down  into  the  water.     When  the  bath  is  over 


THE   BABY'S    TOILET.  73 

the  child  is  lifted  into  the  nurse's  flannel  apron,  the  ri^ht 
hand  supporting  the  legs  and  the  lower  part  of  the  trunk. 
It  is  covered  well,  and  made  to  lie  first  on  its  back  and 
then  on  its  stomach  while  it  is  patted  thoroughly  dry 
with  the  softest  towels.  As  a  finishing  touch  a  little 
powder  is  dusted  about  the  folds  and  hollows  of  the  body 
and  the  baby  is  then  ready  to  be  dressed. 

Succeeding  baths  are  much  like  this  first  one,  with  the 
exception  of  the  oiling.  Many  physicians  advise  only  a 
daily  sponging  until  the  cord  has  separated,  and  after 
this  the  tub-bathing.  There  are  certain  modifications  in 
the  bath,  however,  which  depend  upon  the  age  of  the 
child,  and  these,  with  some  details  regarding  other  mat- 
ters connected  with  the  toilet,  must  be  considered  a  little 
more  particularly. 

The  nature  of  the  baby's  bath-tub  is  of  some  import- 
ance.    For  the  first  bath  a  painted  tin  foot-tub,  or  even 


Fig.  14. — Folding  bath-stand. 

a  large  basin,  will  answer,  but  it  is  well  to  be  pro- 
vided in  advance  with  a  tub  especially  designed  for  a 
baby's  use.  There  are  many  varieties  of  these.  A  ser- 
viceable one  for  constant  employment  is  of  tin,  porce- 
lain, or  agate  iron,  oval  in  shape,  and  with  a  sloping 
back.  A  blanket  may  be  put  into  the  tub  before  it  is 
filled  with  water,  in  order  to  make  the  surface  softer  for 
the  baby's  body.  Wooden  and  papier-mache  tubs  are 
difiicult  to  keep  clean.    As  leaning  over  such  a  tub  while 


74 


THE   CARE    OF   THE  BABY. 


giving  the  bath  is  a  very  back-breaking  procednre,  it  is 
desirable  to  place  it  npon  a  low  stand,  eighteen  or  more 
inches  high,  made  for  the  purpose.  Stands  of  this  sort 
may  be  bought  in  the  shops.  They  are  either  of  perma- 
nent form  or  of  such  a  nature  that  they  can  be  folded  up 
and  put  away  when  not  in  use  (Fig.  14). 


T 


nrfTTT 


Fig.  15. — Bath-tub  on  slats. 


A  very  convenient  device  has  been  described,  intended 
to  obviate  stooping  and  to  render  the  filling  and  empty- 
ing of  the  tub  easier  (Fig.  15).    A  couple  of  strong  slats 


Fig.  16. — Home-made  rubber  bath-tub. 

several  inches  wide,  with  cleats  on  the  under  surface  to 
prevent  slipping,  are  placed  across  the  ordinary  station- 
ary bath-tub  when  needed.  Upon  these  the  baby's  bath- 
tub rests,  and  may  be  filled  by  means  of  a  rubber  hose 


THE   BABY'S    TOILET. 


75 


screwed  to  the  faucets.  It  is  a  good  j^lan  to  attach  the 
tub  to  the  slats  by  straps  wlieii  in  use,  in  order  to  pre- 
vent the  possibility  of  pushing  it  off. 

A  still  more  convenient  tub  made  of  rubber  can  be 
bought.  It  is  of  a  folding  pattern,  which  does  away 
entirely  with  the  stand.  It  occupies  very  little  space 
when  not  in  use,  and  is  especially  serviceable  to  take 
to  summer  resorts  or  when  visiting.  It  may  even  serve 
as  the  baby's  bed.  An  inexpensive  home-made  rubber 
tub  is  shown  in  the  illustration  (Fig.  i6).  The  legs, 
each  of  which  is  thirty  inches  long,  are  pivoted  upon 
the  ends  of  the  central  bar.  This  and  the  four  side- 
bars are  each  thirty-six  inches  in  length.  The  latter 
are  fastened  firmly  to  the  legs.  The  tub  itself  is 
made  of  a  single  piece  of  white  rubber  cloth  thirty 
inches  wide  and  one  and  a  quarter  yards  long.  There 
is  a  hem  at  each  end,  and  through  these  hems 
broad  tapes,  each  nineteen  inches  long,  are  passed  and 
securely   fastened   to   the   ends   of  the   side-bars.      The 

sides  of  the  rubber  cloth  

are  tacked  to  the  top  of 
the  side-bars.  A  small 
plait  at  each  corner  gives 
the  tub  a  better  shape. 
A  little  ingenuity  can 
easily  make  the  legs  de-  ^  ,    . 

Fig.  17. — China  sponge-basin. 

tachable  irom  the  central 

and  side  bars  and  from   each   other,  and  thus  allow  of 

packing  the  tub  into  very  small  space  for  travelling. 

An  outfit  for  bathing  is  not  complete  without  a  rubber 
cloth  or  an  oil-cloth  to  be  laid  beneath  the  tub  to  protect 
the  floor,  and  the  low  chair  with  a  broad  seat  upon  which 
the  nurse  is  to  sit,  and  to  which  reference  has  already 
been  made.     One  of  the  small  china  sponge-basins  made 


76  THE   CARE    OF   TIJE   BABY. 

especially  for  the  baby's  toilet  is  also  very  serviceable. 
It  is  divided  into  two  compartments — one  for  cold  and  one 
for  warm  water  (Fig.  17). 

After  the  child  has  reached  the  age  of  two  or  three 
years  a  second  and  somewhat  larger  tub  may  be  bought. 
This  is  not  an  absolute  necessity,  as  the  ordinary  station- 
ary bath-tub  can  be  used  instead.  It  is,  however,  a  great 
convenience,  and  saves  the  uncomfortable  leaning  over 
which  is  necessary  with  the  latter. 

In  this  connection  it  is  important  to  understand  fully 
the  value  of  early  accustoming  a  baby  to  immersion  in 
water.  I  have  frequently  seen  the  great  fear  of  the  tub 
bath,  shown  by  children  who  had  been  accustomed  to 
sponging  only,  interfere  with  the  use  of  cool  bathing  in 
cases  of  fever  or  of  exhaustion  by  summer  heat,  at  times 
when  it  would  have  been  of  the  greatest  remedial  value. 
Aloreover,  it  is  wellnigh  impossible  to  attain  by  spong.- 
ing  alone,  no  matter  how  thoroughly  done,  the  cleanli- 
ness which  tub-bathing  ensures. 

To  prevent  the  fear  of  the  bath  developing,  we  should 
carefully  avoid  any  sudden  or  rough  plunging  of  the  child 
into  the  water,  and  especially  see  that  the  head  does  not 
accidentally  become  submerged.  Fear  which  has  been 
acquired  in  any  way  may  sometimes  be  overcome  by  cov- 
ering the  tub  with  a  blanket,  placing  the  baby  in  this, 
and  gradually  lowering  baby  and  blanket  into  the  water; 
or  the  child  may  be  put  into  the  empty  tub  and 
allowed  to  play  there  until  it  is  quite  at  home,  and  may 
then  be  accustomed  to  an  amount  of  water  which  is 
increased  a  very  little  day  by  day. 

A  wash-rag  made  of  flannel  or  of  diaper-cloth  should 
be  used  for  applying  soap.  A  delightfully  soft  wash-rag 
is  made  of  cotton  stockinet.  All  the  folds  and  hollows  of 
the  body  must  be  soaped  thoroughly,  but  no  effort  should 
ever  be  made  to  force  the  fingers  or  anvthing  else  into  the 


THE  BABY'S    TOILET.  77 

ears,  and  no  water  should  be  allowed  to  remain  there. 
Severe  inflammation  of  the  ears  has  often  followed  over- 
zealous  attempts  at  cleansing. 

The  scalp  should  be  soaped  daily  during  some  months. 
After  the  age  of  six  months,  however,  it  is  not  advisable 
to  do  this  quite  so  frequently,  as  it  renders  the  hair  dry 
and  brittle.  This  does  not  mean  that  soaping  of  the  head 
is  to  be  neglected  entirely.  The  application  occasionally 
of  a  very  little  vaseline  may  be  of  benefit.  As  the  infant 
grows  into  childhood  the  scalp  should  be  washed  with 
soap  once  or  twice  a  week  at  least,  and  with  water  daily. 
Even  the  long  hair  of  the  girl  need  not  prevent  this. 

The  importance  of  daily  retracting  the  foreskin  of  boy 
babies,  and  of  washing  carefully  beneath  it,  must  not  be 
forgotten  (see  Phimosis). 

For  removing  the  soap-suds  a  sponge  is  better  than  a 
wash-rag,  since  it  permits  of  the  water  being  squeezed 
from  it  in  a  distinct  stream.  Only  the  finest  sponges 
should  be  chosen,  from  which  the  minute  flinty  particles 
have  been  entirely  removed  in  the  process  of  prepara- 
tion. These  little  needle-like  bodies  are  present  in  many 
of  the  cheaper  sponges,  and  are  very  irritating  to  the  skin 
even  of  an  adult.  The  sponge  and  the  wash-rag  should 
be  well  washed  out  and  be  thoroughly  dried  in  the  air 
after  each  bath  and  before  being  used  as^ain.  If  this  is 
done,  there  is  no  objection  to  their  being  kept  in  the  rubber 
pockets  with  which  the  baby's  basket  is  often  furnished. 
For  any  washing  of  the  e}'es  in  the  early  days  of  life  fresh 
absorbent  cotton  is  much  to  be  preferred  to  a  sponge.  A 
fresh  piece  should  be  taken  each  time,  and  used  for 
nothing  else.  The  same  remark  applies  to  the  washing 
of  the  navel,  in  order  to  avoid  the  possibility  of  infecting 
the  wound.  It  should  not  be  rubbed  at  all,  but  the  water 
dropped  upon  it  from  the  cotton. 


78  THE   CARE    OF   THE   BABY. 

Ill  the  choice  of  soap  there  is  a  wide  range.  It  is 
important  to  select  one  which  is  entirely  nnirritating  and 
free  from  an  excess  of  alkali.  Transparent  glycerin  soap 
and  oatmeal  soap  are  good,  but  there  are  few  equal  to 
the  well-known  Castile  soap.  As  there  are  different 
varieties  of  this,  some  of  which  are  not  at  all  suitable,  it 
is  important  to  choose  one  of  the  finest  imported  brands, 
certainly  made  of  olive  oil  and  got  from  a  dealer  of  well- 
known  reliability.  Still  better  are  some  of  the  imported 
German  "  super- fatted  "  soaps.  One  of  these,  called  in 
Germany  a  Basis  Sei/e^  is  intended  especiall}'  for  use 
with  children.  It  is  nnirritating,  and  contains  an  un- 
usual amount  of  oil.  It  can  be  procured  through  drug- 
gists, and  is  probably  the  best  soap  for  infant  use  which 
is  to  be  had  at  the  present  time. 

The  water  used  for  the  bath  should  be  soft  and  clear 
when  it  is  possible  to  obtain  it  so.  Very  hard  water  will 
make  the  skin  rough  and  sore.  It  may  be  improved  by 
boiling,  which  precipitates  much  of  the  lime,  but  it  is 
better  to  substitute  rain-water.  Muddy  water  must  be 
filtered.  This  may  be  done  through  one  of  the  various 
filters  made  to  screw  upon  the  faucet.  A  fairly  service- 
able plan  is  to  tie  a  bag  of  flannel  over  the  opening  of 
the  faucet  and  to  let  the  water  run  very  gently  through 
it.  A  fresh  bag  should  be  used  every  da}-.  The  tem- 
perature of  the  water  is  very  important.  Our  hands  are 
so  made  that  they  accommodate  themselves  readily  to 
degrees  of  heat  or  cold.  They  are  consequently  poor 
guides  ill  determining  the  actual  temperature  of  the 
bath.  The  bared  elbow  dipped  into  the  water  is  much 
more  sensitive  ;  but  if  we  do  not  wish  to  have  the  baby 
sometimes  parboiled  and  sometimes  frozen,  it  is  far  better 
to  use  a  bath  thermometer  (Fig.  i8).  This  may  be  had 
at  any  good  house-furnishing  store  or  drug-store.     The 


THE   BABY'S    TOILET. 


79 


casing  is  made  of  wood,  in  order  that  the  instrument 
shall  not  sink  in  the  water.  To  test  the  temperature  of 
the  bath,  the  thermometer  should  be  moved 
back  and  forth  in  the  water  for  a  few  min- 
utes, and  the  height  of  the  mercury  noticed 
while  the  bulb  is  still  in  it. 

The  temperature  of  the  first  bath  should 
be  ioo°  F. ,  and  that  of  succeeding  ones  be 
lowered  very  gradually  until,  at  the  age  of 
six  months,  the  water  is  at  90°  to  95°  F.  for 
winter  or  at  85°  to  90°  F.  for  summer.  Ac- 
tually cool  baths  should  not  be  given  before 
the  age  of  four  or  five  years,  although  by  two 
years  a  cool  sponging  may  immediately  fol- 
low the  warmer  bath,  providing  the  bracing 
effect  is  produced  which  may  reasonably  be 
expected.  (For  the  temperature  of  hot, 
warm,  and  cool  baths,  etc.,  see  Appendix, 
39.)  Whatever  the  temperature  of  the  bath, 
it  is  important  that  the  head  and  the  face  be 
wet  before  the  rest  of  the  body. 

Enough  water  should  be  used  in  bathing 
to  cover  the  baby  to  the  neck  when  supported  in  a  semi- 
reclining  position.  As  it  grows  older  and  learns  to  sit 
upright  the  water  need  not  reach  above  the  armpits.  The 
duration  of  the  immersion  should  at  first  be  one  or  two 
minutes,  and  later  about  five  minutes.  One  bath  should 
be  given  every  day,  but  in  very  hot  weather,  when  the 
baby  is  evidently  depressed  by  the  heat,  several  cool  baths 
daily  are  sometimes  very  beneficial.  In  such  cases  they 
are  given,  of  course,  for  their  cooling  effect,  not  for 
cleansing  purposes. 

Besides   the   regular    daily    bath,    it    is    important   to 
sponge  the  lower  parts  of  the  body  after  each  bowel- 


FlG.  18.— Bath 
thermometer. 


8o  THE   CARE    OE   THE   BABY. 

movement,  in  order  to  ensnre  perfect  cleanliness.  Simple 
warm  water  is  usually  sufficient  for  this,  and  soap  should 
not  be  employed.  INIost  careful  drying  must  follow.  In 
the  early  months  of  life  an  evening  sponging  of  the  whole 
body  is  often  practised.  It  is  frequently  of  advantage, 
but  is  not  an  essential. 

When  the  child  has  reached  the  age  of  four  years  the 
bathing  ma)'  consist  of  cool  sponging  every  morning 
with  water  at  a  temperature  of  75°  to  80°  F. ,  the  child 
perhaps  standing  in  lukewarm  water,  but  it  is  much 
better  to  continue  the  daily  tub-bathing  with  water  of 
80°  to  85°  F.  Prolonged  soaking  in  hot  water  is  to  be 
condemned  as  excessively  relaxing  and  as  predisposing  to 
catarrhal  conditions.  During  later  childhood  the  tem- 
perature of  the  bath  may  be  reduced  to  75°  or  80°  F.  Of 
course,  at  no  time  of  life  should  a  bath  be  given  soon  after 
a  meal. 

In  this  connection  the  importance  of  following  experi- 
ence rather  than  theory  cannot  be  too  strongly  insisted 
upon  in  regard  to  using  cold  water.  If  a  child  invariably 
shivers  and  continues  cold  after  tepid  or  cold  baths — that 
is,  if  a  proper  "reaction"  does  not  take  place — it  will 
certainly  be  injured  by  continuing  them.  One  must  be 
quite  sure,  however,  before  abandoning  them,  that  there 
is  not  something  wrong  about  the  method  rather  than 
about  the  baths  themselves.  Brief  immersion  and  brisk 
friction  afterward  are  all  that  are  required  to  make  the 
baths  healthful  and  tonic  for  the  majority  of  children. 

The  time  for  bathing  a  child  is  not  so  much  a  matter 
of  importance  as  it  is  that  the  bath  shall  be  given  at  the 
same  hour  every  day,  and  not  too  soon  after  eating.  At 
least  an  hour  should  elapse  after  taking  food.  It  is  also 
better  not  to  allow  the  child  to  go  out  of  doors  imme- 
diately after  bathing,  especially  in  cold  weather.     During 


THE   BABY'S    TOILET.  8l 

the  first  two  or  three  years  of  life  a  morning  hour — 
either  before  breakfast  or  at  about  nine  or  ten  o'clock — 
is  to  be  preferred  unless  an  evening  hour  be  chosen  for 
the  sake  of  relieving  sleeplessness  by  means  of  the  bath. 
On  the  whole,  bathing  before  breakfast  is  to  be  preferred 
for  infants,  as  the  later  morning  hour  interferes  with  the 
morning  outing.  This  is  especially  true  in  winter-time, 
since  the  daylight  of  the  afternoon  is  too  short  to  allow 
an  infant  to  be  out  sufficiently  long.  Later  the  daily 
bath  is  best  given  when  the  child  rises  in  the  morning. 

A  fuller  consideration  of  baths  of  different  tempera- 
tures and  of  different  sorts,  particularly  as  used  in  dis- 
ease, will  be  found  in  the  Appendix  (39-54). 

The  choice  of  towels  is  of  some  importance.  Especially 
for  young  babies  they  should  be  of  the  softest  and  most 
absorbent  material.  An  old  diaper  constitutes  one  of  the 
best  of  towels  at  this  age,  and  later  in  life  Turkish  towel- 
ing, not  new,  is  excellent.  After  the  drying  it  is  well 
to  rub  the  baby  briskly  with  the  palm  of  the  hand  until 
its  skin  is  slightly  reddened,  in  order  to  establish  a  good 
circulation  of  the  blood.  Sometimes  rubbing  with  warm 
alcohol  or  warm  bathing  whiskey  or  with  a  little  olive 
oil  is  of  distinct  value  for  delicate  children. 

Some  difference  of  opinion  exists  regarding  the  advisa- 
bility of  powdering  the  child  after  the  bath.  In  theory, 
the  drying  should  be  so  perfect  that  powder  is  not  needed. 
In  practice,  however,  it  is  difficult  to  obtain  this  perfect 
dryness,  or  to  appreciate  the  failure  until  the  production 
of  chafing  and  fissures  of  the  skin  shows  that  there  has 
been  a  fault  in  this  respect.  It  is  therefore  a  useful  plan, 
after  using  the  towel  as  thoroughly  as  possible,  to  powder 
the  folds  of  the  skin,  as  around  the  neck,  about  the  ears, 
in  the  armpits  and  groins,  and  behind  the  knees.  The 
powder  used  should  be   of  the   simplest  kind,    such  as 


82  THE   CARE    OF   THE   BABY. 

finely-powdered  starch  or  lycopodiuni,  or,  still  better, 
talc.  It  is  best  to  avoid  the  various  scented  powders  on 
the  market,  since  they  may  contain  impurities.  Some- 
times a  little  vaseline  or  cold  cream  may  be  applied  with 
advantage  instead  of  the  powder.  This  is  especially  true 
if  the  creases  in  the  skin  appear  to  be  somewhat  too  dry. 

We  must  consider  briefly  the  subject  of  out-door  bath- 
ing, and  particularly  of  sea-baths.  The  action  of  salt 
water  seems  often  to  produce  a  peculiarly  beneficial  effect 
upon  weakly  children.  Too  much  cannot  be  said  against 
the  exhibition  of  basest  cruelty  winch  may  so  often  be 
seen — a  father  or  mother  carrying  a  screaming,  terrified 
little  one  of  tender  age  into  the  breakers.  The  exposure 
to  the  cold  water  and  the  action  of  the  great  fright  can 
be  nothing  but  very  injurious.  The  only  fit  place  for 
infants  to  take  a  salt  bath  is  the  tub.  There  is  no 
harm,  however,  in  dressing  a  child  of  three  years  of  age, 
or  even  younger,  in  bathing-clothes,  protecting  it  from 
the  sun  by  a  bathing-hat  of  suitable  size,  and  allowing  it, 
on  a  calm,  warm  day,  to  paddle  in  the  ripples  on  the  sand 
or  to  play  in  the  pools  of  sun-warmed  water  left  by  the 
receding  tide.  In  this  way  the  child's  confidence  in  the 
harmlessness  of  the  water  is  established,  and  at  the  same 
time  the  good  effects  of  sea-bathing  are  gained  without 
fright.  The  mother  must  never  forget  to  watch  carefully 
against  chilling  by  too  long  a  wetting  or  by  exposure  to 
strong  winds  in  moist  clothes. 

Older  children  who  have  acquired  a  love  for  surf-bath- 
ing or  fresh-water  bathing  would  apparently  remain  in 
the  water  for  ever  if  permitted  to  do  so.  The  mother 
must  enforce  a  limitation  of  the  bath  to  ten  minutes  at 
the  longest  if  the  water  is  cool,  or  twenty  to  twenty-five 
minutes  if  warm.  Chattering  of  the  teeth  and  blueness 
of  the  lips  are  indications  that  the  bath  should  cease,  no 


THE  BABY'S    TOILET.  83 

matter  how  short  it  may  have  been.  The  after-effects 
are  a  still  better  guide  in  the  matter.  Exhaustion  or 
lassitude  during  the  rest  of  the  day  renders  necessary  a 
reduction  of  the  length  of  the  baths  or  of  their  fre- 
quency.    Not  every  child  can  bear  a  daily  out-door  bath. 

In  the  case  of  sea-bathing  it  is  important  to  guard 
against  blows  of  the  breakers  against  the  ears,  since 
injury  to  the  drums  may  result.  The  mere  gentle  enter- 
ing of  the  water  into  the  ears  is  harmless. 

There  are  certain  other  matters  connected  with  the 
toilet  which  can  best  be  considered  in  this  connection. 
Prominent  among  these  is  the  washing  of  the  mouth  and 
teeth.  Babies  are  much  disposed  to  various  forms  of 
inflammation  of  the  mouth.  It  is  necessary,  therefore, 
that  a  toilet  of  the  mouth  be  performed  systematically, 
and  yet  it  is  just  as  important  that  this  be  done  with  the 
greatest  care  and  gentleness,  or  there  will  be  produced 
the  very  trouble  which  we  are  striving  to  prevent. 
Nurses  often  forget  their  own  size  and  strength  and 
roughly  force  a  big  finger  into  a  delicate  little  mouth, 
thereby  doing  much  more  harm  than  good.  To  perform 
the  toilet  properly  a  little  absorbent  cotton  should  be 
wrapped  around  the  little  finger  or  around  a  smooth 
stick,  taking  care  that  the  cotton  project  decidedly  be- 
yond the  end,  and  with  this  moistened  in  boiled  luke- 
warm water  and  used  gently  the  washing  can  be  done 
very  satisfactorily.  It  should  be  repeated  three  or  four 
times  a  day,  or,  better  still,  after  each  feeding,  of  course 
using  a  fresh  piece  of  cotton  on  each  occasion.  After 
the  child  begins  to  secrete  saliva  in  abundance  and  to 
move  the  tongue  freely  it  is  unnecessary  to  wash  the 
mouth  so  frequently. 

IMothers  often  think  that  it  is  a  matter  of  no  conse- 
quence if  the  milk  teeth  decay,  since  they  will  soon  fall 


84  THE    CAKE    OE   THE   BABY. 

out  in  any  case.  Tliis  is  far  from  the  truth,  for  not  only 
does  their  decay  detract  greatly  from  the  child's  good 
looks  and  become  a  fruitful  source  of  toothache,  but  their 
imperfection  or  loss  is  a  cause  of  indigestion  from  insuf- 
ficient mastication,  and  may  even  cause  irregularity  in 
the  position  of  the  permanent  teeth. 

The  washing  of  the  mouth  should  be  continued  as  the 
earliest  teeth  are  cut,  and  the  teeth  themselves  thoroughly 
rubbed  with  a  moistened  cloth  morning  and  evening. 
After  the  majority  of  the  milk  teeth  are  through  the 
gums,  a  small  tooth-brush  with  soft  bristles  of  badger- 
hair  or  specially  softened  pig-bristles  is  to  be  preferred. 
If  any  stains  appear  on  the  teeth,  a  little  precipitated 
carbonate  of  lime  in  finely-powdered  form  may  be  used 
on  the  brush.  If  this  does  not  prove  successful  in  remov- 
ing the  discoloration,  a  small  pine  stick,  such  as  a  match- 
stick,  may  be  sharpened  into  a  chisel-shaped  edge,  moist- 
ened, dipped  in  finely-powdered  pumice-stone,  and  rubbed 
upon  the  spots  until  they  are  removed.  Care  must  be 
taken  to  avoid  injuring  the  gums  while  using  the  stick. 
The  collection  of  tartar  upon  the  teeth  is  the  commonest 
cause  of  inflammation  and  receding  of  the  gums,  and 
nothing  but  diligent  watchfulness  will  prevent  it. 

As  early  as  possible  the  child  should  be  taught  itself  to 
use  the  tooth-brush  and  powder  twice  daily,  and  to  draw 
waxed  floss  silk  between  the  teeth  or  to  use  a  quill  tooth- 
pick— in  private — after  each  meal.  Should  decay  take 
place,  it  is  all-important  to  have  the  trouble  corrected  by 
a  dentist.  Indeed,  it  is  best  in  any  case  to  let  the  baby 
pay  its  first  visit  to  him  not  later  than  the  age  of  two 
years,  and  after  this  regularly  at  intervals  of  six  months. 
In  this  way  the  milk  teeth  may  be  prevented  from  decay- 
ing, and,  in  addition,  will  not  be  allowed  to  remain  in 
place  after  they  have  commenced  to  interfere  with  the 
cuttimr  of  the  second  set. 


THE   BABY'S    TO /LET.  85 

Besides  the  washino;  of  the  hair,  of  which  we  have 
already  spoken,  it  is  of  course  necessary  to  brush  it,  not 
only  for  appearance'  sake,  but  also  because  frequent 
thorough  brushing  improves  the  scalp.  The  hair-brush 
for  the  baby's  first  use  is  made  of  camel's  hair,  in  order 
not  to  irritate  the  scalp.  As  the  child's  hair  increases  in 
quantity  and  becomes  less  fine,  a  coarser  brush  must  be 
procured,  with  bristles  stiff  enough  to  remove  all  dan- 
druff from  the  skin.  Combs  of  any  sort  ought  to  be 
employed  only  to  part  the  hair,  and  even  for  this  purpose 
it  is  not  advisable  to  use  them  in  infancy,  except  with  the 
greatest  care.  The  hair  should  be  trimmed  often.  It  is 
true  that  short  hair  is  not  so  pretty,  but  it  adds  to  the 
comfort  of  the  child,  and  even  little  girls  of  four  or  five 
years  or  older  ma}'  wear  the  hair  short  with  decided  ad- 
vantage in  this  respect.  They  will  easily  make  up  lost 
time  when  it  is  finally  allowed  to  grow  uninterruptedly. 
Certainly  no  boy  should  be  made  to  wear  long  hair  in 
curls  after  he  puts  on  trousers,  unless  his  mother  wishes 
to  subject  him  to  the  ridicule  of  his  boy  companions. 
Contrary  to  a  commonly-accepted  idea,  the  cutting  of  the 
hair  has  no  effect  in  improving  its  growth.  So,  too,  the 
clipping  of  the  eyelashes  does  no  good.  They  do  not 
become  longer  as  a  result  of  this,  but  may  grow  coarse. 

The  cutting  of  the  finger-nails  and  toe-nails  requires 
some  attention.  The  finger-nails  should  be  kept  trimmed 
\vith  scissors,  yet  not  down  to  the  quick  nor  too  much  at 
the  corners.  They  may  be  kept  clean  with  a  soft  nail- 
brush, and  all  the  hang-nails  be  cut  off  close  to  the  skin. 
The  toe-nails  should  be  cut  straight  across,  and  the  cor- 
ners should  never  be  rounded  off  The  following  of  this 
plan  will  aid  in  the  prevention  of  ingrowing  toe-nails. 

The  completion  of  the  baby's  toilet — namely,  dressing 
— can  be  more  conveniently  considered  when  stud)ing 
the  nature  of  the  clothes,  in  the  next  chapter. 


86  THE   CARE    OF   THE   BABY. 

CHAPTER   V. 
THE  BABY'vS  CLOTHES. 

In  this  chapter  we  must  first  consider  the  clothing 
required  in  earliest  infancy  ;  then  that  needed  after  short- 
ening of  the  clothes  has  taken  place;  and,  finally,  that  to 
be  used  after  baby-clothing  is  abandoned.  The  chief 
requirements  of  an  infant's  dress  are  looseness,  softness, 
warmth,  and  simplicity.  We  usually  avoid  in  this 
country  the  custom  prevalent  in  some  others — that  of 
wrapping  a  child  in  swaddling-clothes  in  which  it  is 
actually  rolled  up  like  a  small  bundle.  Yet  even  with  us 
infants  often  are  not  dressed  in  a  way  to  allow  of  the 
freedom  of  motion  that  is  desirable.  The  binder  is  so 
tight  that  the  ribs  and  abdomen  are  compressed  and 
digestion  is  greatly  interfered  with,  and  sometimes  even 
vomiting  is  produced,  and  the  skirts  are  so  long  that  the 
baby  can  move  its  legs  only  with  difficulty. 

The  clothing  should  be  soft  and  light,  in  order  that 
the  delicate  baby-skin  be  not  irritated.  Not  only  soft- 
ness in  surface  but  softness  in  texture  also  is  required; 
that  is,  the  material  ought  to  be  porous  and  not  too 
heavy,  in  order  that  evaporation  of  perspiration  and  the 
proper  ventilation  of  the  skin  may  take  place.  Simplic- 
ity is  also  important.  This  does  not  mean  merely  that 
the  clothing  be  simply  made,  but  that  the  whole  arrange- 
ment be  simple  as  well.  If  the  garments  are  elaborate, 
not  only  is  the  expense  of  providing  them  very  greatly 
and  unnecessarily  increased,  but,  more  especially,  the 
temptation  arises  of  letting  them  be  worn  too  long  with- 
out washing.  Still,  if  a  mother  desires  to  make  the 
baby's  clothing  of  this  nature,  there  is  no  real  objection 


THE   BABY'S  CLOTHES.  87 

to  it  although  it  may  not  be  wise.  The  other  kind  of 
simplicity,  however,  is  a  positive  requisite.  Every  un- 
necessary garment  renders  the  exertion  of  being  dressed 
and  the  burden  of  the  clothes  that  much  greater.  To  be 
rolled  first  on  its  stomach  and  then  on  its  back  an  indef- 
inite number  of  times  while  one  layer  of  clothing  after 
another  is  put  upon  it  cannot  but  be  very  distressing  to 
the  baby. 

Finally,  and  the  most  important  of  all,  the  child's 
clothing  must  be  warm.  Children,  particularly  in  in- 
fancy, are  peculiarly  unable  to  resist  the  depressing 
effects  of  cold,  and  every  care  must  be  taken  to  guard 
against  this.  In  prematurely-born  infants  life  depends 
largely  upon  the  maintenance  of  the  body-heat.  We 
all  know,  or  ought  to  know,  that  it  is  not  the  part  which 
is  exposed  which  necessarily  feels  the  effect  of  exposure. 
A  child  may  develop  pneumonia  or  diarrhoea  just  as  easil}^ 
from  chilling  of  the  arms  or  legs  as  from  direct  exposure 
of  the  chest  or  abdomen.  Consequently,  the  custom  of 
dressing  with  thin  sleeves  or  with  short  dresses  and  bare 
legs  cannot  be  too  strongly  condemned.  It  is  a  practice 
which  in  cool  weather  is  both  dangerous  and  cruel.  No 
parent  would  be  willing  to  dress  in  that  way,  even  did 
custom  sanction  it.  Even  in  summer-time  it  is  dangerous, 
especially  in  infancy.  A  child  will  be  little,  if  any, 
warmer  with  a  thin  covering  over  the  legs,  and  will  un- 
doubtedly be  very  much  safer.  It  is  a  great  mistake  to 
try  to  "harden"  a  child  by  letting  draughts  blow  .on  it 
and  by  covering  it  with  insufficient  clothing. 

Garments  which  are  loose,  and  those  made  of  material 
of  loose  texture,  are  warmer  than  others,  on  account  of 
the  air  which  they  retain  in  their  folds  and  interstices; 
for  air,  as  is  well  known,  is  a  very  poor  conductor  of 
heat.     There  is  no  material  which,  in  theory  at  least, 


88  THE    CARE    OF   THE   BABY. 

answers  all  the  requirements  as  well  as  wool.  It  is  at  once 
soft,  loose-textured,  liglit,  and  warm.  With  the  excep- 
tion of  the  diapers,  all  the  clothing  which  comes  next  to 
the  skin  of  the  child  should,  when  possible,  be  made  of 
wool.  Its  weight  must,  of  course,  vary  with  the  season 
of  the  year,  and  its  texture  should  always  be  of  the  ver>' 
softest.  All-wool  woven  material  or  machine-knitted 
goods  serve  this  purpose  well. 

While  all-wool  garments  next  the  skin  are  much  to 
be  preferred  from  a  hygienic  point  of  view,  there  are 
some  grave  objections  to  them.  First  among  these  is 
their  great  tendency  to  shrink,  and  consequently  to 
become  both  harsh  in  texture  and  much  too  tight.  The 
fact  that  so  many  ways  of  preventing  this  have  been 
proposed  indicates  that  none  of  them  is  entirely  satis- 
factory. Now  and  then  a  laundress  will  be  found  who 
really  understands  the  washing  of  woollens,  but  this  is 
certainly  the  exception.  x\  method  of  overcoming  this 
difficulty  consists  in  the  employment  of  "merino  "  goods, 
made  of  a  mixture  of  cotton  and  wool,  or  of  goods  con- 
sistinor  of  silk  and  wool  combined.    Yet  even  these  shrink 

o 

badlv  if  too  much  wool  is  present. 

The  other  chief  objection  is  that  to  some  babies'  skins, 
particularly  in  hot  weather,  all-wool  clothing  is  very 
irritating.  In  such  cases  a  garment  of  silk  or  of  linen 
may  be  worn  under,  or  in  place  of,  the  woollen  one,  de- 
pending upon  the  thickness.  Yet  linen,  and  silk  to  a 
less  extent,  is  apt  to  be  chilling,  and  a  better  practice  is 
to  use  merino  goods  of  a  sort  which  contains  only  a  small 
portion  of  wool,  or  machine-knitted  goods  entirely  of 
cotton.  This  soft  porous  cotton  stockinet,  made  of  dif- 
ferent thicknesses  for  summer  and  winter,  is  very  satis- 
factory. 

Having  now  considered  some  of  the  general  principles 


THE  BABY'S  CLOTHES. 


89 


wliicli  underlie  the  choice  of  materials  used  in  the  dress- 
ing of  children,  we  may  look  more  in  detail  into  the 
character  of  the  individual  articles  required.  Most  of 
them  can  be  made  at  home,  and  paper  patterns  for  them 
may  be  bought  of  the  dealers.  It  is  more  convenient, 
however,  although  less  economical,  to  buy  the  garments 
ready  made,  and  some  of  the  clothes,  such  as  all  the 
close-fitting  ones,  are  much  better  when  not  made  at 
home.  The  larger  establishments  for  children's  and  in- 
fants' clothing  keep  a  line  of  varying  sizes  and  weights. 

The  binder,  or  abdominal  band,  is  the  term  applied  to 
the  bandage  which  is  commonly  placed  around  the 
child's  abdomen  next  to  the  skin.  Many  physicians  are 
opposed  to  it  utterly,  and  there  is  no  question  but  that  it 
is  capable  of  doing  great  harm  if  improperly  used.  As 
a  means  of  support  it  is  entirely  unnecessary.  The  only 
object  of  the  bandage  is  at  first  to  keep  the  umbilical  cord 
from  being  pulled  upon  by  the  clothes,  and,  later,  to  furnish 
a  loose  covering  to  the  abdomen  to  pre- 
vent chilling.  It  can  be  done  away  with 
if  the  sliirt  is  made  to  fasten  to  the  dia- 
per, but  on  the  whole  it  is  an  advantage, 
provided  only  we  remember  that  most 
important  fact,  that  a  binder  must  never 
bind.  Nurses  are  much  disposed  to 
draw  it  very  snug.  This  makes  colic 
worse  when  the  baby  is  troubled  with 
gas,  by  not  allowing  the  abdomen  to 
distend  ;  and  there  is  danger,  too,  of 
producing  rupture  in  the  same  way,  in- 
stead of  preventing  it,  as  it  is  sometimes 
supposed  that  a  close  binder  will   do. 

The  best  form  of  binder  is  the  knitted  circular  one,  on 
account  of  the  greater  elasticity  which  it  possesses.    This 


Fig 


jj 
19. — Abdmiiinal 
binder. 


90  THE   CARE    OF   THE  BABY. 

can  be  bought  ready  made,  or  can  be  knitted  or  crocheted 
at  home.  It  should  be  circular,  and  be  wide  enough  to 
extend  from  the  hips  well  over  the  ribs — that  is,  about 
six  inches  (Fig.  19).  It  may  be  made  with  shoulder- 
straps  if  desired,  or  may  be  simply  pinned  to  the  shirt. 
There  is  usually  a  little  tab  in  front  to  which  the  diaper 
may  be  pinned.  If  it  is  desired  to  make  the  binder  of 
flannel,  it  should  be  of  the  width  mentioned,  and  long 
enough  to  go  somewhat  more  than  once  around  the 
body — that  is,  about  twenty  inches  in  length.  The 
flannel  should  be  of  the  softest  kind,  cut  bias  in  order 
to  increase  its  elasticity,  and  unhemmed.  The  knitted 
binder  is,  however,  preferable,  except,  possibly,  for  the 
first  week  of  life,  or  until  the  cord  separates.  The  flan- 
nel binder  is  more  easily  applied  at  this  time,  and  occa- 
sions less  danger  of  pulling  the  cord,  but  Avith  even  ordi- 
nary care  the  other  can  be  readily  used  from  the  first. 

Diapers,  or  napkins,  should  be  made  of  soft,  light,  and 
absorbent  material,  and  it  is  important  to  have  them  not 
too  heating,  especially  in  summer.  Perhaps  the  best 
materials  are  linen  and  cotton  diaper-cloths.  Each  of 
these  has  its  advantages.  Linen  is  cooler  and  less  bulky, 
while  cotton  is  more  absorbent.  Canton  flannel  is  not  to 
be  recommended,  as  it  is  too  little  absorbent,  and  soon 
becomes  harsh  as  a  result  of  washing.  The  dia])ers  for 
the  early  months  of  life  should  be  a  yard  long  and  half  a 
yard  wide  when  hemmed.  The  material  should  be 
washed  before  it  is  cut,  to  prevent  shrinking  afterward. 
By  the  time  the  child  is  three  months  old  the  width  will 
often  need  to  be  increased  to  twenty  inches  and  the  length 
also  to  double  this,  and  by  about  nine  months  further 
increase  in  size  must  often  be  made.  The  diaper  is 
folded  into  a  square,  and  this  again  into  a  triangle, 
making  four  thicknesses  in  all.    A  second  diaper  may  be 


THE   BABY'S   CLOTHES.  9 1 

folded  into  a  square  and  be  laid  under  the  hips  to  prevent 
the  moisture  reaching  the  clothes  ;  or  it  may  be  pinned 
around  the  waist  in  the  usual  triangular  form,  but  with 
the  point  allowed  to  hang  down  behind.     Instead  of  this 


Fig.  20  — Diaper  with  diaper-square. 

arrangement,  which  is  rather  heating  and  bulky,  espe- 
cially in  summer,  it  is  often  a  good  plan  to  use  a  small 
diaper  folded  two  or  more  times  to  form  a  square  of  nine 
or  eleven  inches  ("  diaper-square  ") — -just  large  enough  to 
receive  the  urine  and  the  passages  from  the  bowels.  This 
square  is  held  in  place  by  a  thinner  and  larger  linen 
diaper,  which  surrounds  the  hips  in  the  usual  way  (Fig. 
20).  An  excellent  diaper  can  be  purchased  of  cotton 
stockinet.  It  is  not  only  very  soft  and  absorbent,  but 
also  is  shaped  to  fit  the  hips,  and  must  be  much  more 
comfortable  to  the  baby  than  the  ordinary  form  is. 

A  rubber  or  other  waterproof  cover  should  never  be 
applied  outside  the  diaper.  It  is  very  heating  and  is 
liable  to  produce  chafing  and  eczema. 

The  diapers  should  always  be  changed  just  as  soon  as 
soiled,  and  should  on  no  account  be  put  on  again  until 
they  have  been  washed,  even  though  they  have  been 
moistened  with  colorless  urine  only.  It  is  always  dan- 
gerous simply  to  dry  them  and  then  to  use  them  again. 


92  THE   CARE    OF   THE   BABY. 

Nothing  but  pure  soap,  not  too  alkaline  in  character, 

should  be  employed  in  washing  them,  and  soda  ought  to 

be  avoided  carefully,  as  otherwise  a 

E  great  deal  of  irritation  of  the  skin 
may  result.  They  should  be  passed 
through  several  rinsings  of  fresh 
water,  to  be  sure  that  all  soap  has 
been  removed.  After  washing  they 
should  be  aired  for  a  day  before  they 
,.  .     ,      ,        are  used,   in  order   that   thev   may 

Fig.  21.  —  Knitted  sock. 

become  thoroughly  dry.  All  new 
diapers  ought  to  be  washed  several  times  before  the  baby 
uses  them,  in  order  to  render  them  quite  soft. 

The  rule  regarding  the  immediate  changing  of  the 
soiled  diaper  is  open  to  exception  during  the  night.  It 
would  manifestly  be  nnwise  to  rouse  a  bab>-  e\-ery  time 
it  chanced  to  pass  urine  at  night.  If  it  wakes  of  itself, 
the  wet  diaper  should  be  changed. 

Crocheted  or  knitted  socks  are  an  essential  if  the  baby's 
skirts  are  made  as  short  as  is  advisable,  and  even  with 
the  longest  skirts  they  are  to  be  recommended.  They 
are  made  of  silk  thread  or  of  soft  yarn,  reach  fully  half- 
way to  the  knee,  and  tie  about  the  ankle  with  a  narrow 
silk  ribbon  or  a  knitted  cord  (Fig.  21). 

All  babies  are  clothed  in  much  the  same  way  as  re- 
gards the  garments  already  mentioned,  but  for  the  rest 
we  have  the  choice  of  several  forms  of  clothing.  Of 
course,  various  minor  modifications  exist,  but  there 
appear  to  be  three  principal  styles  on  which  these  are 
based.  The  first  or  oldest  style  consists  of  a  shirt,  a 
skirt  fastened  to  a  broad  muslin  band  and  called  a  "  bar- 
row coat"  or  "pinning  blanket,"  often  a  second  petti- 
coat, and  then  an  outside  dress  or  slip.  The  second 
variety  is  like  the  first,  except  for  the  important  differ- 
ence that  the  band  of  the  petticoat  is  replaced  by  a  loose 


THE   BABY'S   CLOTHES.  93 

waist  with  arm-holes  ;  or  the  whole  garment  is  made  in 
"Princess"  style — that  is,  without  a  distinct  waist.  In 
the  third  form,  very  often  called  the  "Gertrude  suit," 
the  ordinary  shirt  is  done  away  with,  and,  as  originally 
described,  the  binder  also,  and  the  costume  consists  of 
three  garments,  all  of  the  Princess  pattern. 

The  first  style  of  dressing,  not  so  often  employed  now 
as  formerly,  is  decidedly  objectionable.  In  this  the  pet- 
ticoat consists  of  a  skirt  of  flannel  reaching  below  the 
feet  and  attached  to  a  muslin  band  which  is  deep  enough 
to  reach  from  the  armpits  to  the  hips.  This  band  must 
of  necessity  be  long  enough  to  overlap  considerably,  to 
permit  of  pinning  and  to  give  room  for  growth.  Such  a 
garment  as  this  breaks  all  the  rules  that  we  discussed 
as  requisite  for  infants'  clothing.  It  is  cumbersome,  it 
is  more  difficult  to  put  on,  and,  above  all,  it  is  too 
tight.  The  closeness  of  application  required  to  enable 
the  band  to  support  the  weight  of  the  skirt  exerts  far 
more  pressure  than  the  delicate  ribs  of  the  baby  should 
receive. 

The  second  style  of  body-clothing  is  one  which  can 
be  highly  recommended.  The  shirt  should  be  made 
of  one  of  the  materials  already 
recommended  for  use  next  the 
skin.  For  winter  it  should 
be  warm  ;  for  summer,  made 
of  the  same  materials,  but 
thinner,  and  for  the  hottest 
weather,  very  thin.  In  all  sea- 
sons it  should  be  long  enough 
to  reach  below  the  hips,  and 
should  have  sleeves  extending  p,^  22— Shirt, 

to  the  wrists,  and  a  high  neck. 

It  should  be  open  the  full  length  in  front,  and  be  fastened 
by  small  flat  buttons  (Fig.  22).     It  should  be  sufficiently 


94 


THE   CARE    OF   THE   BARY. 


loose  not  to  compress  the  chest  even  after  some  shrinkage 
in  washing.  A  shirt  with  a  chest-measure  of  fifteen  inches 
is  generally  sufficient  during  the  first  three  months  of 
life.  If  it  is  too  large,  a  smooth  plait  may  be  taken  at 
each  side.  The  shrinkage  from  washing  can  be  avoided 
to  a  considerable  extent  by  stretching  the  garment  over 
a  wooden  form  while  drying. 

The  best  material  for  the  petticoat  is  white  flannel. 
The  best  form  is  one  which  is  made  throughout  in 
Princess  style  and  with  arm-holes  without  sleeves.  It 
should  be  open  above  at  the  back,  and  be  made  to  fasten 


Fig.  23. — Infant's  long  petticoat. 


Fig.  24. — Infant's  dress. 


with  one  or  two  small  flat  buttons  or  with  a  narrow  rib- 
bon to  tie  at  the  neck.  In  warm  weather  the  petticoat 
ma}'  consist  of  a  flannel  skirt  with  a  loose  muslin  waist 
(Fig-  23). 

It  is  a  great  mistake  to  make  infants'  skirts  too  long, 
as  it  serves  no  good  purpose,  and  impedes  very  greatly 
the  freedom  of  their  motions — that  exercise  of  their  lees 


THE   BABY'S   CLOTHES.  95 

which  is  so  to  be  desired.  The  petticoat  should  reach 
not  more  than  six  to  ten  inches  below  the  feet.  A  length 
of  twenty-five  inches  from  the  neck  to  the  hem  is  qnite 
sufficient.  Some  mothers  prefer  to  have  a  second  cam- 
bric petticoat  over  this,  as  it  prevents  the  flannel  showing 
through  the  dress,  but  this  makes  an  extra,  unnecessary- 
garment  and  complicates  the  process  of  dressing. 

The  slip  or  dress  is  of  cambric  or  nainsook,  loose, 
and  of  any  style  that  suits  the  mother's  fancy.  It 
should  fasten  behind  with  buttons  or  a  narrow  ribbon, 
and  should  have  sleeves  coming  to  the  wrists  (Fig.  24). 
Its  length  should  equal  or  slightly  exceed  that  of  the 
petticoat.  Of  course,  both  the  slip  and  the  bottom  of 
the  petticoat  may  be  trimmed  according  to  taste. 

The  third  style  of  clothing,  the  Gertrude  suit,  consists, 
as  stated,  of  three  garments,  and  neither  close-fitting  shirt 
nor  binder  is  used.  The  use  of  the  binder,  however, 
does  not  interfere  with  the  plan  of  the  suit.  All  these 
garments  are  cut  in  Princess  style.  As  originally  de- 
scribed, the  inner  one,  which  takes  the  place  of  the  ordi- 
nary shirt  and  may  be  called  the  "Gertrude  shirt,"  con- 
sisted of  Canton  flannel,  reached  from  the  neck  to  ten 
inches  below  the  feet — that  is,  was  twenty-five  inches 
in  all  in  length — had  sleeves  to  the  wrist,  and  all  the 
seams  on  the  outside.  The  middle  garment,  correspond- 
ing to  the  ordinary  petticoat,  was  of  flannel,  had  scalloped 
neck  and  arm-holes  without  sleeves,  and  was  half  an  inch 
larger  around  and  two  to  four  inches  longer.  The  third 
garment,  the  slip,  was  of  the  ordinary  material,  with  high 
neck  and  long  sleeves,  and  was  slightly  wider  than  the  last 
and  thirty  or  more  inches  in  length.  All  were  fastened 
behind  with  two  or  three  small  buttons.  The  chief  ad- 
vantage of  this  style,  apart  from  the  looseness,  is  the 
very  great  convenience  in  dressing.  The  three  are  put 
together,  one  within  the  other,  and  sleeve  within  sleeve, 


96  THE    CAKE    OF   THE   BABY. 

before  they  are  put  on,  and  then  all  are  drawn  on  at  one 
time  as  though  they  were  but  one. 

The  material  of  the  suit  has  since  been  modified  in 
various  ways.  The  inner  garment  is  better  made  of 
something  else  than  Canton  flannel.  One  of  the  mate- 
rials alread)  recommended  for  use  next  the  skin  is  far 
superior.  The  second  garment  may  be  made  of  flannel 
for  winter  or  of  muslin  for  summer.  The  outer  slip  is  of 
cambric  or  nainsook,  as  usual.  There  is  no  necessity  of 
having  the  garments  so  long;  twenty-eight  inches  is  long 
enough  for  the  slip,  and  somewhat  less  for  the  two  other 
garments.  This  allows  the  child  greater  freedom  of 
movement,  yet  without  exposing  it  to  danger  of  taking 
cold.  If  there  is  found  to  be  a  tendency  for  the  air  to 
enter  at  the  back,  owing  to  the  fact  that  three  garments 
open  at  the  same  position,  the  difficulty  can  be  readily 
overcome  by  having  the  outer  garment  open  in  the  centre 
of  the  back,  the  middle  one  somewhat  to  one  side,  and 
the  inner  one  slightly  toward  the  other  side. 

The  Gertrude  suit  is  certainly  an  excellent  one.  It  is 
superior  to  the  second  style  described  in  the  convenience 
attending  dressing,  but  is  perhaps  inferior  in  that  the 
under-garment  does  not  adhere  so  closely  to  the  body, 
and  is  therefore  more  apt  to  let  the  air  reach  the  skin. 
This  objection,  however,  is  not  of  so  much  moment 
while  the  baby  is  still  in  long  clothes. 

There  are  certain  other  suits  advertised  and  used  to 
some  extent  which  are  in  all  essentials  made  after  the 
plan  of  the  Gertrude  suit  device. 

If  the  mother  desire  it,  she  can  have  thebab\'s  clothes 
open  in  front  instead  of  behind.  This  has  the  theoretical 
advantage  that  the  child  does  not  have  to  lie  upon  but- 
tons, tapes,  or  pins.  Practically,  it  makes  little  differ- 
ence if  the  clothing  is  put  on  carefully  and  the  child  is 
not  laid  upon  a  hard  surface. 


THE  BABY'S  CLOTHES. 


97 


The  length  of  garments  in  inches  as  given  applies  only 
to  the  first  two  or  three  months.  They  can,  of  course,  be 
made  with  a  hem  sufficient  to  let  out  as  the  baby  grows. 
So,  too,  the  buttons  can  be  shifted  and  the  wrist-bands 
lengthened  if  the  garments  have  been  made  large  enough 
at  the  outset.  It  is  better,  however,  not  to  have  too  many 
clothes  at  first,  and  to  buy  or  make  larger  sizes  as  needed. 

The  clothes  for  the  night  should  be  a  complete  change 
from  those  worn  during  the  day.  They  consist  of  a 
binder,  a  diaper,  a  shirt  either  of  the  ordinary  pattern  or 
of  the  Gertrude  style,  according  to  preference,  and  an 
outer  night-slip.  This  latter  should  be  longer  than  the 
day-slip,  and  very  roomy  in  order  to  allow  of  free  move- 
ment of  the  legs.  For  winter-time  it  should  be  of  flan- 
nel, Canton  flannel,  or  cotton  stockinet,  and  made  to  close 
with  a  drawing-string  or  with  buttons  at  the  bottom  (Fig. 
25).  For  hot  summer  weather  it  may  be 
of  muslin,  and  need  not  be  fastened  below. 
The  baby  requires  no  socks  when  in  bed, 
but  may  have  some  night-socks  to  slip  on 
when  it  has  to  be  taken  up.  The  necessity 
for  fastening  down  the  bed-covers  if  the 
baby  is  restless  is  referred  to  again  in  the 
chapter  on  Sleep. 

A  certain  number  of  Sfarments  are  needed 
besides  those  mentioned.  There  is,  in  the 
first  place,  the  old  blanket  in  which  the 
child  shall  be  received  immediately  after 
birth,  and  which  has  been  spoken  of  in 
describing  the  contents  of  the  baby's  bas- 
ket in  Chapter  IV.  There  should  also  be 
a  warm  shawl  or  shoulder-blanket,   made  8°^^"  closed  by  a 

r  Ci.    n  11-1  t,      4-1  drawin<^-string    at 

ot  verv  soft  flannel,  which  can  be  thrown    ,     ,   ^        "= 

'  _  _      tlie  bottom. 

about  the  baby  and  over  its  head  when  it 
is  carried  from  one  room  to  another  or  when  it  is  taken 
7 


Fig.  25. — Night- 


98 


THE   CAKE    OF   THE  BABY. 


lip  at  nio^ht.  The  shoulder-blanket  should  not  be  used 
except  under  these  circumstances.  A  cap  to  be  worn  in 
the  house  is  not  needed  unless  the  child  shows  a  great 
disposition  to  take  cold.  A  thin  cambric  cap  is  then 
sufficient,  but  even  this  should  not  be  used  except  by  the 
advice  of  the  physician  in  charge.  A  knitted  worsted 
sack  is  often  useful  if  the  room  happens  to  be  cooler  than 
usual.  A  flannel  or  wash-flannel  wrapper  is  also  very  ser- 
viceable in  the  mornings,  before  the  baby  receives  its  bath. 
The  clothing  for  use  out  of  doors  varies,  of  course, 
with  the  season.  In  winter  there  is  needed  a  long,  very 
warm  cloak  (Fig.  26)  of  some  woollen  material  such  as 
cashmere  ;  a  warm  thick  lined  hood 
covering  the  ears  ;  a  Shetland  veil 
if  the  weather  is  windy  or  cold  ;  and 
warm  knitted  mittens.  In  hot  sum- 
mer weather  only  a  cap  is  required. 
This  should  be  thin,  of  cambric  or 
silk.  Occasionally  a  neutral  tinted 
or  darker  veil  is  required  to  protect 
the  eyes  if  the  glare  out  of  doors  is 
very  great. 

We  may  pause  here  just  a  moment 
over  the  steps  to  be  followed  in  the 
actual  process  of  dressing  a  young 
infant,  although  this  is  something 
which  seems  to  come  almost  intui- 
tively to  most  mothers.  After  the 
new-born  baby  is  bathed  and  dried 
it  is  laid  upon  its  back  in  the  nurse's 
lap,  with  the  diaper  in  position  under  its  hips.  The 
nurse  sits  in  the  low  chair  already  referred  to  (p.  69).  If 
a  binder  of  flannel  is  ysed,  it  should  at  the  same  time  be 
laid  in  place  under  the  back.     The  stump  of  the  umbil- 


Infant's  cloak. 


THE   BABY'S  CLOTHES.  99 

ical  cord  is  now  dressed.  The  best  method  of  doing  this 
is  to  envelop  it  well  in  salicylated  absorbent  cotton, 
which  can  be  procnred  at  any  first-class  drng-store.  It 
is  then  wrapped  abont  with  thread  and  laid  against  the 
abdomen  npon  the  left  side.  The  binder  is  then  brought 
up  from  each  side  and  pinned  with  safety-pins,  or,  if  the 
circular  knitted  binder  is  used,  is  drawn  up  over  the  feet. 
It  ought  always  to  be  so  loose  that  the  hand  will  slip 
easily  between  it  and  the  skin.  The  diaper  is  now  brought 
around  from  the  sides  and  back,  and  pinned  with  a  safety- 
pin  to  the  top  of  the  band,  taking  care  that  the  hand  can 
slip  under  it  readily,  as  in  the  case  of  the  binder.  The 
socks  are  next  put  on,  and  then  the  shirt.  The  petticoat 
and  dress  are  first  adjusted  to  each  other  and  are  then 
slipped  on  together  over  the  feet.  After  the  baby  is  old 
enough  to  sit  alone  they  may  conveniently  be  slipped  over 
the  head.  If  the  Gertrude  suit  is  used,  all  three  garments 
are  slipped  on  at  one  time  after  having  first  been  put 
together,  sleeve  within  sleeve. 

At  bed-time  all  clothing  worn  during  the  day  is  re- 
moved, a  fresh  binder  and  diaper  are  applied,  and  the 
night-clothes  put  on.  If  the  Gertrude  clothing  is  used, 
the  under-garment  and  the  night-gown  are  first  fitted 
together  and  are  then  put  on  at  the  same  time. 

Every  day,  at  the  time  of  the  morning  bath,  the  um- 
bilical cord  must  be  carefully  freed  from  the  cotton,  using 
great  caution  to  avoid  pulling  it.  After  the  bath  it  may 
be  powdered  with  boric  acid  if  there  is  any  moisture  or 
unpleasant  odor  about  it,  and  a  fresh  dressing  of  cotton 
must  be  applied.  By  the  fourth  or  fifth  day  the  stump 
will  have  fallen  off  and  the  dressing  of  the  cord  will  no 
longer  be  required.  If  the  baby  is  sponged  instead  of 
being  put  in  the  tub  during  the  first  few  days  of  life, 
there  is  no  need  to  remove  the  orisfinal  dressing  from 


lOO  THE    CARE    OF   THE  BABY. 

the  cord,  provided  it  seems  dry  and  entirely  witliout 
Ddor. 

There  is  scarcely  anything  about  which  there  is  so  little 
uniformity  of  opinion  as  the  number  of  changes  of  cloth- 
ing which  should  be  provided  in  advance  for  the  baby. 
This  is  not  only  because  mothers  vary  in  the  frequency 
with  which  they  have  laundry  work  done,  but  also  be- 
cause the  number  of  garments  which  can  be  made  to 
answer  very  well  where  economy  is  a  matter  of  considera- 
tion may  not  seem  at  all  sufficient  to  those  anxious  to 
have  the  bab}'  very  abundantly  supplied. 

The  following  list  of  clothing — the  layette,  as  it  is  com- 
monly called — may  be  considered  one  of  average  size: 

Long  Clothes. 

Flannel  binders 3 

Knitted  bands 4 

Diapers 4  dozen  or  more. 

Shirts,  close-fitting  or  Gertrude 6 

Petticoats,  flannel;  or  second  Gertrude  garment   .    .  4 

Petticoats,  cambric  (if  desired) 4 

Slips      8 

Socks 6  pairs. 

Night-gowns 6 

Wrappers 3 

Sacks,  knitted 2 

Cloak I 

Hood I 

Mittens i  pair. 

Veil I 

Shoulder-blankets 2 

There  are  certain  other  articles  to  be  provided  in  ad- 
vance, but  they  are  more  appropriately  described  else- 
where, when  considering  the  baby's  basket  and  the 
baby's  bed.     There  is  one,  however,  and  a  very  service- 


THE   BABY'S  CLOTHES.  10 1 

able  one,  which  may  be  mentioned  here — namely,  the 
lap-protector,  although  this  is  rather  for  the  mother's  use 
than  for  the  baby's.  A  very  good  pattern  is  shaped  like 
a  pillow-case,  fastens  at  one  end  by  buttons,  and  is  made 
of  corduroy,  Turkish  toweling,  or  some  similar  thick, 
washable  material.  It  may  be  trimmed  simply  in  any 
way  desired.  A  doubled  piece  of  rubber  sheeting  is  made 
to  slip  inside  of  it.  The  rubber  may  be  slipped  out,  and 
both  it  and  the  case  washed  when  soiled.  Instead  of  this, 
lap-protectors  may  be  made  of  squares  of  nursery  cloth, 
which  can  be  thrown  away  when  soiled.  Still  another 
useful  article  is  a  small  soft  pillow  on  which  the  baby 
can  lie  or  be  carried  about  during  the  early  weeks  of  life. 
When  the  baby  has  reached  the  age  of  six  months, 
more  or  less,  depending  on  the  season  of  the  year,  the 
time  for  "shortening"  the  clothes,  or  "short-coating," 
has  come.  The  change  should  not  be  made  in  winter  if 
it  can  be  avoided.  The  number  and  material  of  the  gar- 
ments remain  nearly  the  same  as  before.  The  shortening 
may  be  accomplished  by  cutting  down  the  skirts  of  the 
long  clothes  already  in  use,  lengthening  the  sleeves,  and 
letting  out  the  waists  if  they  have  been  made  sufficiently 
large  at  first  to  allow  of  this.  In  the  case  of  the  Ger- 
trude suit,  however,  the  shortened  skirts,  reaching,  as 
they  do,  only  to  the  ankles  or  a  little  higher,  allow  too 
free  access  of  air  to  the  trunk.  It  is  therefore  advisable 
to  replace  the  inner  loose  garment  by  a  close-fitting,  long- 
sleeved,  and  high-necked  shirt.  The  use  of  the  binder 
is  continued.  Short  clothes  also  necessitate  a  decided 
change  in  the  covering  of  the  feet  and  legs,  which  would 
otherwise  be  left  too  much  exposed  to  the  air.  There  is, 
of  course,  a  great  temptation  for  the  admiring  mother  to 
leave  the  baby's  plump  little  legs  bare,  but  the  practice 


I02  THE   CARE    OF  THE   BABY. 

is  capable  of  doing  great  harm.  Tliere  should  be  stock- 
ings long  enongh  to  reach  to  the  diaper.  They  may  be 
pinned  to  this,  but  a  better  way  is  to  button  them  to 
broad  elastic  bands  which  can  be  buttoned  or  tied  to  tapes 
fastened  to  the  inside  of  the  upper  part  of  the  petticoat, 
or  to  a  separate  waist  if  one  is  worn  (pp.  104  and  no). 
Stockings  of  wool  or  of  partly  woollen  goods,  and  of  a 
thickness  var\'ing  with  the  season  of  the  year,  are  prob- 
ably to  be  preferred,  but  they  frequently  shrink  so  badly 
that  cotton  or  raw  silk  stockings  are  often  more  practi- 
cally useful,  especially  in  summer-time.  The  shrinking 
may  be  prevented  to  a  considerable  extent  by  stretching 
them  over  a  wooden  stocking-frame  while  drying.  The 
toe  should  not  be  pointed,  and  the  whole  stocking-foot 
should  not  fit  too  closely,  since  the  constant  elastic  pres- 
sure which  it  exerts  may  do  harm.  Indeed,  the  stock- 
ings ought  to  be  rights  and  lefts,  and  narrowed  off  on  the 
outside  of  the  foot,  if  such  forms  can  be  bought  or  made. 
A  great  breadth  of  toe  is  very  desirable.  Care  must  be 
observed  that  the  interior  is  perfectly  smooth  and  free 
from  loose  threads,  knots,  and  wrinkles. 

The  stockings  should  be  white  or  of  some  color  which  is 
known  not  to  contain  any  injurious  substance  capable  of 
irritating  the  skin.  In  winter  it  is  sometimes  of  advan- 
tagfe  to  furnish  a  child  in  short  clothes  with  drawers  also. 
These  may  be  made  of  woollen  or  merino  goods  or  of  Can- 
ton flannel.  It  is  convenient  to  make  the  legs  separate, 
to  button  or  pin  to  the  upper  part  of  the  petticoat.  They 
should  fit  rather  closely  and  should  reach  to  the  shoe-tops 
(Fig.  27).  Drawers  of  this  pattern  combined  with  the 
use  of  short  stockings  may  entirely  take  the  place  of  long 
stockings  throughout  the  year,  if  it  is  so  desired.  In  this 
case  their  weight  varies,  of  course,  with  the  season.     Ex- 


THE  BABY'S  CLOTHES. 


103 


cept  that  they  are  more  easily  changed  when  wet,  they 
Iiave  no  special  advantage  over 
long  stockings,  and  the  latter 
alone  generally  answer  every  pur- 
pose until  the  age  when  the  dia- 
per is  abandoned. 

When  the  baby  becomes  more 
active,  and  especially  when  it  be- 
gins to  creep  or  to  stand,  there  is 
often  a  great  deal  of  trouble  with 
the  diapers,  which  exhibit  a  tend- 
ency to    fall  off  at    the  most   inop-  Fig.  27.— Drawers  with   sepa- 

portune  moments,    unless   drawn  ''^'^  ^^s^" 

much  more  tightly  than  is  healthful.  To  obviate  this 
difficulty  the  diapers  may  be  pinned  to  the  merino  shirt, 
provided  little  squares  of  muslin  be  first  sewed  on 
the  latter,  to  prevent  the  pins  tearing  holes;  or  the 
binder  may  be  made  with  shoulder-straps  and  with  a  little 
tag  in  front  to  which  the  diaper  can  be  attached.  Dia- 
per-suspenders have  been  recommended  to  meet  the  dif- 
ficulty: they  consist  of  a  band  of  muslin  about  three 
inches  wide,  and  long  enough  to  go  around  the  waist 
and  to  button  in  front.  Two  pieces  of  white  silk  elastic 
are  attached  to  this,  as  shown  in  the  illustration  (Fig. 
28),  so  as  to  cross  over  the  shoulders.  A  little  tag  is 
sewed  on  one  end  of  the  band,  and  another  at  the  middle, 
and  to  these  the  diaper  is  pinned  after  the  suspenders 
have  been  applied  outside  of  the  shirt.  It  is  important 
not  to  have  too  many  thick  folds  of  diaper  between  the 
baby's  thighs  when  walking  is  commenced,  as  it  tends 
to  produce  bowing  of  the  legs. 

Another  very  serviceable  article  is  the  "diaper 
drawers"  (Fig.  29).  These  are  made  in  the  shape  of  a 
triangle,  fasten  about    the  waist  by  buttoning  in  front, 


I04 


THE    CAKE    OF   THE   BABY. 


and  are  supported  by  pinning  to  the  band  or  by  fastening 
to  the  waist  referred  to.  The  stockings  may  be  fastened 
to  the  diaper-drawers  if  desired.  Put  on  over  the  diaper, 
they  serve  to  keep  this  in  place  and  to  protect  the  under- 
clothes from  being  soiled.      Very  neat  and  light  little 


Fig.  28. — Diaper-suspenders. 


JJ)2C 

Fig.  29. — Diaper-drawers. 


waists  can  be  bought  or  made,  and  to  these  both  diapers 
and  stockings  may  be  fastened,  in  place  of  any  of  the 
plans  mentioned.  (See  also  p.  iio. )  If  such  a  waist  is 
employed,  the  flannel  skirts  may  be  made  without  waists 
of  their  own,  but  with  a  band  buttoning  to  the  same  waist 
to  which  the  diaper  is  fastened.  If  a  white  skirt  is  also 
used,  it  may  be  made  to  button  to  the  same  waist.  Having 
the  skirts  thus  separate  obviates  the  necessity  of  undress- 
ing the  baby  to  so  great  an  extent  in  case  they  become 
wet  from  the  diaper  and  require  to  be  changed. 

With  the  short  dresses  the  baby  may  put  on  shoes, 
although  it  does  not  really  need  them  until  it  begins  to 
stand  or  to  creep.  In  place  of  these  we  may  at  first  use 
moccasins  of  chamois  leather,  kid,  or  felt.  These  are  for 
sale  in  the  shops,  but  they  can  be  easily  made  at  home. 
They  form  a  very  serxiceable  foot-covering,  although 
there  is  difficulty  in  keeping  them  on  unless  they  are 
well  made  and  rather  high  on  the  ankle.  The  first  real 
shoes  should  be  of  soft  kid,  with  kid  or  thin  leather  soles, 
and    of  course  without  heels.     Their  shape  is  of  great 


THE   BABY'S   CLOTHES. 


105 


importance,  since  the  softness  of  the  tissues  renders  the 
deforming  of  the  feet  by  improper  shoes  very  easy.  Not 
only  should  the  shoe  be  somewhat  longer  than  the  foot 
and  fully  as  wide,  but  it  should  be  made  to  fit  the  foot, 
not  the  foot  forced  to  fit  the  shoe.  The  toe  should  be 
wide  and  loose  to  permit  the  foot  to  spread,  but  the 
instep  and  heel  should  fit  closely  or  the  foot  will  turn  and 
rub.  Flat  laces  are  better  than  buttons,  since  they  allow 
of  a  more  perfect  adaptation.  The  shoes  ought  always 
to  be  rights  and  lefts,  for,  although  a  baby's  foot  is  fat 


Fig.  30. — Imprint  of  foot  (from 
life,  three-quarters  natural  size). 


Fig.  31. — Outline  of  sole  of  shoe 
to  fit  Fig.  30. 


and  plump,  it  is  in  reality  built  on  exactly  the  same 
lines  as  the  adult  foot — that  is,  the  undeformed  adult  foot. 
The  illustration  (Fig.  30)  is  of  the  sole  of  the  right  foot 
of  a  child  of  thirteen  months.  It  is  a  reproduction  from 
life,  reduced  to  three-quarters  of  the  natural  size,  made 
by  rubbing  the  sole  with  a  little  lampblack  stirred  in 
turpentine  and  sweet  oil,  and   then  pressing  it  against 


Io6  THE   CARE    OF   THE   BABY. 

blotting-paper  pinned  on  a  board.  The  illustration 
seems  unnatural  and  distorted  at  first  sight,  yet  it  shows 
how  a  foot  actually  presses  upon  the  ground  in  walking, 
and  proves  the  great  importance  of  having  the  shoes 
rights  and  lefts  even  from  the  beginning.  The  out- 
line in  the  adjoining  illustration  (Fig.  31)  represents  the 
shape  of  the  sole  of  a  shoe  which  would  fit  this  foot.  For 
actual  use,  it  should,  of  course,  be  made  slightly  larger  in 
order  to  keep  the  uppers  from  exercising  undue  pressure. 

Shoes  of  a  proper  pattern  were  difficult  to  obtain,  since 
shoemakers  found  it  easier  to  make  them  on  the  old 
model,  according  to  which  either  one  will  fit  equally 
well — or  rather  ill — on  either  foot.  Although  the  mak- 
ing of  children's  shoes  which  reallv  fitted  the  feet  had 
repeatedly  been  urged  by  physicians,  yet  until  recently 
such  could  be  obtained  only  for  little  children,  but  not 
for  infants.  There  is  now,  however,  no  difficulty  in 
procuring  from  the  leading  dealers  shoes  which  are 
rights  and  lefts,  and  which  conform  to  the  natural  shape 
of  the  foot  of  the  youngest  age  needing  shoes  at  all. 

Sometimes  a  baby  suffers  greatly  from  cold  feet  shortly 
after  it  first  begins  to  wear  stockings  and  shoes.  Fre- 
quent rubbing  of  the  bare  feet  and  the  making  of  the 
shoes  somewhat  looser  about  the  instep  and  ankle  will 
overcome  the  trouble.  After  the  bab}'  is  walking  out  of 
doors  the  thickness  and  stiffiiess  of  the  sole  must  be 
increased,  to  protect  the  foot  from  being  injured  by  irreg- 
ularities in  the  ground. 

Knitted  sacks  are  still  needed  during  the  time  short 
infant-clothing  is  worn,  and  wrappers  serve  the  same 
purpose  as  before.  The  wrapper  should  be  long  and 
loose,  and  neither  it  nor  the  night-slip  partakes  in  the 
general  shortening.  Even  before  the  time  of  shortening, 
bibs  may  be  needed  to  catch  the  greatly  increased  flow  of 
saliva.     These  should  be  made  of  soft^  absorbent  cotton 


THE   BABY'S   CLOTHES. 


107 


P"iG.  32. — Bib. 


material,  and  be  quilted  (Fig.  32).  There  is  no  objec- 
tion to  the  placing  of  a  somewhat  smaller  bib  of  rubber 
cloth  under  the  cotton  one.  Later,  larger 
bibs  will  be  required  for  use  when  the 
child  is  eating.  A  very  serviceable  arti- 
cle when  the  baby  begins  to  creep  is  a 
creeping  apron.  The  drawers  already 
described  answer  to  a  certain  extent,  but 
a  much  better  device  is  the  creeping 
apron  shown  in  the  illustration  (Fig.  33). 
The  lower  portion  consists  of  a  wide, 
roomy,  bag-like  shirt,  closed  at  the  bottom  and  large 
enough  to  hold  the  skirts  easily.  This  is  fastened  to  a 
yoke  above,  which  is  provided  with  wide  sleeves  and 
wide  arm-holes  to  permit  of 
the  arms  easily  slipping  into 
them.  At  the  lower  end  of 
the  apron  are  two  openhigs  for 
the  legs.  These  are  gathered 
into  bands  fitted  to  the  legs 
and  are  made  to  fasten  below 
the  knee.  There  should  be  a 
distance  of  fifteen  inches  be- 
tween the  holes.  The  whole 
width  of  the  skirt  at  the  lower 
end  should  be  twenty-seven 
or  more  inches.  This  device 
will  effectually  protect  all  the  garments  and  will  check 
the  action  of  draughts  along  the  floor.  Creeping  aprons 
of  this  description  can  easily  be  made  at  home,  but  can- 
not, I  think,  be  bought  in  the  shops.  If  the  mother 
finds  the  upper  portion  to  be  too  warm,  the  yoke  and 
sleeves  may  be  dispensed  with,  and  the  bag-skirt  be 
gathered  into  a  band,  from  which  shoulder-straps  may 
pass  over  the  shoulders   and  cross  over  the  back.     Of 


Fig.  T)T,. — Creeping  apron. 


I08  THE   CARE    OF   THE   BABY. 

course  this  latter  plan  fails  to  prevent  the  sleeves  of  the 
baby's  slip  from  becoming  soiled. 

There  is  a  form  of  creeping  apron  sometimes  recom- 
mended and  sold  which  should  be  avoided.  It  consists 
of  a  very  wide  pinafore  gathered  at  the  bottom  of  the 
skirt  into  a  band,  which  fastens  around  the  waist  under 
the  clothes.  This  arrangement  protects  the  clothing 
well,  but  leaves  the  legs  more  than  usually  exposed, 
since  it  holds  the  skirts  away  from  them. 

For  outdoor  use  a  coat  whicli  is  shorter  than  the  long 
cloak  of  infancy  is  needed  after  the  child  has  learned  to 
walk.  Warm  knitted  leggings  which  cover  the  whole 
lower  half  of  the  body  up  to  the  waist  are  serviceable  in 
cold  weather.  Tliose  made  of  Jersey  are  still  better,  as 
they  are  just  as  warm  and  much  less  bulky. 

The  following  list  may  serve  as  a  guide  to  the  number 
of  garments  needed  at  this  time  of  life: 

Short  Clothes. 

Knitted  binders 4 

Diapers 4  dozen. 

Shirts,  close-fitting 6 

Petticoats,  flannel 4 

Petticoats,  cambric  (if  desired) 4 

Dresses 8  to  12 

vStockings 8  to  12  pairs. 

Shoes 2  pairs. 

Drawers  (if  desired) 8  to  12  pairs. 

Creeping  aprons 2 

Wrappers 3 

Sacks 3 

Bibs       12 

Night-gowns 6 

Cloak  or  coat i 

Hood  or  cap i 

Leggings i  pair. 

Veil I 

Mittens i  pair. 


THE  BABY'S  CLOTHES. 


109 


The  time  for  changing  from  the  clothing  of  infancy  to 
that  of  childhood  depends  not  so  much  upon  the  age  as 
npon  the  time  when  the  baby  learns  to  do  without  a 
diaper.  Two  years  of  age  is  a  very  late  period  for  acquir- 
ing the  proper  control,  and  most  children  should  be  able 
to  have  the  change  made  by  a  3^ear  or  earlier,  at  least 
during  the  day-time,  if  there  has  been  careful  training. 

After  the  change  has  been  made  it  is  still  important 
to  ensure  thorough  protection  against  cold,  while  at  the 
same  time  the  clothes  are  loose.  The  style  of  garments 
and  their  number  is  a  matter  of  minor  consequence,  and 
may  be  determined  largely  according  to  the  fanc}'  of  the 
mother,  although  the  binder  should  be  worn  until  the 
age  of  two  years.  With  the  exception  of  the  head  and 
hands,  no  part  of  the  body  should  be  left  exposed  to  the 
air,  unless  it  be  on  the  very  hottest  days  of  summer,  and 
even  then  the  child  is  little,  if  any,  warmer,  and  is  cer- 
tainly much  safer,  if  fully  covered  with  garments  of  very 
light  weiofht   and  texture.     The  undershirt   should   be 


Fig.  34. — Closely  fitting  drawers.  Fig.  35. — Muslin  drawers. 

long-sleeved  and  high-necked,  and  of  woollen  or  merino 
of  a  thickness  depending  on  the  season  of  the  year. 
The  drawers  for  winter  use  (Fig.  34)  should  be  of  the 


no 


THE    CARE    OE   THE   BABY. 


warmest  material,  such  as  Canton  flannel  or  closely  fitting 
woollen  goods.  It  is  very  customary  to  cover  these  with 
short  muslin  drawers  (Fig.  35)  for  the  sake  of  appearance. 
In  summer  the  long  winter  drawers  may  be  replaced  by 
closely  fitting,  very  thin  drawers  of  the  same  shape,  or 
the  lighter  short  muslin  drawers  may  be  worn  alone,  de- 
pending largely  on  the  temperature  and  the  climate  in 
general.  The  stockings  should  vary  in  thickness  with 
the  season,  but  should  always  be  long.  A  loosely-fitting, 
high-necked,  sleeveless  waist  (Fig.  36),  of  warm  material 


Fig.  36.— Waist. 

for  winter  and  of  muslin  for  summer,  is  conveniently 
worn  over  the  shirt.  To  this  the  stocking-supporters 
and  drawers  are  attached,  and  in  summer  the  white  skirt 
(Fig.  37)  as  well.  Circular  garters  ought  never  to  be 
worn.  In  winter  the  child  must  wear,  in  addition,  a 
flannel  skirt  attached  to  a  muslin  waist  of  its  own,  to 
which  the  white  skirt  also  may  be  buttoned  (Fig.  38). 
Instead  of  this  plan  both  skirts  may  be  detachable,  and 
buttoned  to  the  same  waist  if  desired. 

The  child's  outer  dress  may  be  of  material,  quality, 
and  ornamentation  in  accord  with  the  season  and  the  pre- 


THE   BABY'S   CLO'J'IIES. 


Ill 


vailing  styles.  It  is  most  customary  to  keep  children  in 
white  dresses  until  the  age  of  two  or  three  years.  This 
is  not  necessary,  however,  but  if  colors  in  light  woollen 
material,    or   in  cottons  for   summer,    are   preferred    on 


Fig.  37.— White  skirt. 


Fig.  38. — Flannel  skirt  with  waist 
attached. 


account  of  the  saving  of  laundry  work,  it  is  well  to  re- 
member that  certain  colors  for  use  in  the  sunshine  are 
much  hotter  than  others.  Black  is  twice  as  hot  as  white, 
and  blue,  even  light  blue,  nearly  as  hot  as  black.  Red 
stands  about  midway  between  black  and  white,  with  green 
hotter  and  yellow  cooler  than  it. 

The  long  skirts  reaching  almost  to  the  ground,  which 
have  been  at  times  the  fashion  for  small  children,  espe- 
cially girls,  are  not  at  all  to  be  recommended.  They  are 
very  much  in  the  way,  and  oppose  a  great  hinderance  to 
the  active  movements  which  are  so  much  to  be  desired. 

As  the  child  grows  older  its  style  of  dressing  will,  of 
course,  vary  according  as  it  is  a  girl  or  a  boy.  The  time 
and  manner  of  showing  the  difference  of  sex  by  the  dress 
is  not  a  matter  with  which  we  can  concern  ourselves 
greatly  in  a  book  of  this  nature,  and  we  must  consider  it 
only  briefly.     No  change  at  all  is  made  until  the  age  of 


I  12 


THE    CARE    OE   THE   BABY. 


about  two  years,  depending  upon  the  size  of  the  child. 
At  this  time  boys  wear  dresses  made  with  box  plaits  from 
the  neck  (Fig.  39),  held  in  at  the  back  by  a  belt  which 
comes  from  the  side  seams,  or,  if  preferred,  goes  entirely 
around  the  waist  ;  while  girls  still  wear  the  baby-dress, 
gathered  in  a  yoke  (Fig.  40).     Next  comes  oftenest  a  kilt 


Fig.  39. — Costume  for  boy. 


Fig.  40. — Costume  for  girl. 


or  Russian  blou.se  suit  for  boys,  made  in  various  designs. 
At  from  two  to  four  years  of  age,  depending  on  the  size 
and  shape  of  the  child  and  the  wish  of  the  parents,  the 
boy  is  put  into  trousers,  either  knickerbockers  or  the 
popular  sailor  costume. 


THE  BABY'S   CLOTHES. 


113 


An  important  matter,  with  girls  just  as  much  as  witli 
boys,  is  that  the  same  precautions  to  ensure  looseness  and 
warmth  of  the  clothing  shall  be  taken  at  this  age  as 
earlier  in  life.  If  corsets  must  finally  be  worn — as  inex- 
orable Fashion  still  says  they  must — let  the  girl  in  her 
formative  stage  defer  adopting  them,  or  even  corset- 
waists,  just  as  long  as  possible.  Her  whole  future  well- 
being  may  depend  upon  this  and  similar  early  provisions 
for  her  health.  There  is  nothing  in  all  this  which  means 
that  her  clothes  shall  look  ugly  or  ill-fitting. 

The  night-dress  of  children  who  have  ceased  to  wear 
baby  clothes  consists  of  a  merino  shirt, 
of  thickness  varying  with  the  season, 
and  of  night-drawers  which  are  of 
Canton  flannel  or  cotton  stockinet  in 
winter  and  muslin  or  outing  flannel 
in  summer.  The  very  frequent  ten- 
dency which  some  children  have  to 
toss  off  the  night-covering  often  ren- 
ders it  advisable  to  provide  the  drawers 
with  feet,  so  that  the  whole  body  ex- 
cept the  head  and  hands  is  constantly 
covered  (Fig.  41).  A  slit  at  the 
ankle  allows  the  foot  to  be  pushed 
through  and  the  stocking  to  be  put 
on  in  the  morning  without  exposing 
the  child.  Not  until  well  on  in  later 
childhood,  at  least  in  winter,  should 
night-gowns  be  made  for  the  girls, 
and  night-shirts,  or,  still  better,  paja- 
mas, for  the  boys. 

For  out-of-door  wear  both  sexes 
continue  to  wear  hoods  or  caps  until 
the  age  of  two  years  or  earlier,  when  boys  grenerally  re 

8 


Fig.  41. — Night-drawers 
with  closed  feet. 


114  THE    CARE    OF  THE  BABY. 

place  them  by  little  hats.  The  use  of  a  warm  hood,  or 
of  some  other  form  of  head-covering  which  protects  the 
ears,  should  certainly  be  adopted  in  winter.  Warm  wraps 
and  coats  are  needed  in  winter,  their  nature  depending 
upon  the  child's  age  and  sex.  The  soles  of  the  shoes  are 
gradually  increased  in  thickness  as  the  child  grows  older, 
and  at  about  the  age  of  three  or  four  )ears  the  part  under 
the  heel  is  made  slightly  thicker — /.  ^.,  has  a  "spring." 
The  spring  is  later  made  somewhat  more  pronounced,  but 
it  is  only,  as  a  rule,  at  about  the  age  of  ten  or  eleven 
years  that  actual  heels  are  used.  Sometimes  boys'  shoes' 
are  given  heels  somewhat  earlier,  in  order  to  make  a  dis- 
tinction from  the  shoes  of  girls.  Leather  leggings  lined 
with  flannel  are  very  popular  for  children  of  three  or 
four  years  and  over.  Rubber  over-shoes  should  alwa^'s 
be  worn  if  the  ground  is  at  all  damp.  Rubber  boots 
permit  the  child  to  play  in  the  snow  or  on  very  wet 
ground.  In  later  childhood  mackintoshes  serve  to 
protect  from  rain.  Before  this  time  it  is  better  that 
the  child  stay  in  the  house  in  rainy  weather.  We  must 
never  forget  the  possible  danger  of  contracting  cold  after 
the  use  of  waterproof  clothing,  from  the  fact  that  the 
body  becomes  damp  from  the  retained  perspiration.  After 
the  use  of  rubber  boots  the  feet  should  be  thoroughly 
dried  and  the  stockings  changed. 

The  following  list  represents  the  clothes  required  for 
late  infancy  and  early  childhood  up  to  the  period  when 
trousers  are  adopted  by  the  boy.  More  drawers  are 
needed  at  first  than  later,  on  account  of  the  occasional 
lapses  in  the  recently  acquired  control  over  the  bladder. 


THE  BA^BY'S   CLOTHES.  II5 

CivOTHING  FOR   lyATE  INFANCY  AND   EARLIEST  CHILDHOOD. 

Binders  (up  to  two  years  of  age) .4 

Shirts 6 

Drawers 6  to  12 

Stockings 6  to  8  pairs. 

Shoes 2  pairs. 

Underwaists 4 

Flannel  skirts  with  waists  attached 4 

White  skirts 4 

Dresses 6  to  12 

Night-drawers 4 

Sacks 2 

Cap  or  hat i 

Leggings i  pair. 

Coat I 

Mittens  or  gloves      i  pair. 

Rubber  shoes i  pair. 

A  few  very  brief  comments  are  necessary  regarding  the 
clothing  required  during  sickness.  When  the  child  is  in 
bed  it  should  be  dressed  in  night-clothes  identical  with 
those  usually  worn.  The  garments  should  be  changed 
night  and  morning,  and  be  aired  and  warmed  thoroughly 
before  they  are  used  again.  There  can  never  exist  any 
necessity  of  making  a  child  go  without  changing  its 
clothing  for  days  or  weeks  for  fear  it  will  take  cold.  If 
the  change  is  made  properly,  there  is  no  risk.  It  is  very 
important  that  the  arms  and  chest  be  well  covered  with  a 
sack  of  some  sort  when  the  child  is  awake.  After  it  is 
well  enough  to  be  out  of  bed  and  to  sit  in  a  chair  a  flan- 
nel wrapper  and  knit  or  felt  shoes  are  useful.  Slippers 
are  often  dangerous,  as  they  expose  the  feet  to  draughts. 


Il6  THE    CAKE    OE   THE   BABY. 

CHAPTER  VI. 
FEEDING  THE  BABY. 

In  this  chapter  we  shall  consider  what  is  often  one  of 
the  most  difficult  of  all  the  questions  of  babyhood;  the 
rock  upon  which  many  and  many  a  little  bark  has  made 
shipwreck. 

There  are  practically  but  two  ways  to  feed  an  infant — 
namely,  either  on  human  milk  at  the  breast  of  the  mother 
or  of  a  wet-nurse,  or  upon  an  artificially  prepared  milk 
diet — and  we  have  the  two  corresponding  classes  of  the 
breast-fed  and  the  bott/c-fed  hohy.  Happy  are  the  little 
ones  who  belong  to  the  first  class,  for  there  is  no  question 
whatever  that  the  natural  and  proper  food  for  infants  is 
human  milk.  Statistics  show  beyond  doubt  that  breast- 
fed babies  as  a  class  are  larger  and  healthier  than  the 
bottle-fed  ones,  and  that  the  mortality  among  them  is  far 
less.  The  most  careful  preparation  cannot  possibly 
make  the  milk  of  another  animal  chemically  identical 
with  that  of  a  woman  or  similar  in  its  effects  on  the  child. 
It  is  undoubtedly  true  that  the  demands  made  upon  the 
time  of  the  nursing  mother  are  most  exacting,  and  that 
nursing  is  probably  much  the  greatest  inconvenience  of 
motherhood.  Still,  the  mother-love  should  certainly 
prompt  the  self-sacrifice. 

Let  us,  then,  first  consider  breast-feeding.  Many  vary- 
ing directions  are  given  regarding  the  time  when  the 
baby  should  be  first  put  to  the  breast.  We  cannot  do 
better  in  this  respect  than  treat  the  child  like  any  other 
little  new-born  animal  which  is  not  prevented  by  cast- 
iron  rules  from  nursing  as  soon  as  it  feels  inclined.  The 
natural  instinct  of  a  baby  is  to  suck,  and  it  should  be 


FEEDING    THE   BABY.  WJ 

allowed  to  do  this  as  soon  as  the  mother  feels  sufficiently 
rested  to  permit  it,  after  both  she  and  the  child  have  been 
washed  and  dressed.  This  practice  of  early  nursing  is  a 
good  one,  for  the  reason  that  it  tends  to  ensure  thorough 
contraction  of  the  womb.  It  is  true  that  there  is  very 
little  in  the  breast  during  the  first  two  or  three  days. 
There  is  usually  something,  however — a  thin,  yellowish, 
sticky  fluid  looking  like  poorly-developed  milk,  and 
called  colostrum.  This  is  of  a  peculiar  character,  since, 
besides  being  of  a  nourishing  nature,  it  probably  has  a 
somewhat  purgative  action  upon  the  child's  bowels  ;  and 
it  is  advisable  that  these  be  well  opened  early  and  the 
blackish  contents  {meconium)  discharged.  It  is  only  by 
about  the  third  day  after  confinement  that  the  secretion 
of  milk  becomes  well  established. 

The  early  sucking  by  the  child  fulfils  still  other  pur- 
poses besides  those  mentioned.  It  both  stimulates  the 
secretion  of  milk  and  draws  out  the  nipples  into  better 
shape  for  the  baby's  future  use.  If  the  nipple  is  some- 
what depressed  or  poorly  developed,  it  is  much  easier  for 
the  child  to  suck  at  it  while  the  breast  is  still  flaccid 
than  after  it  has  become  full  and  tense  with  the  con- 
tained milk. 

Many  monthly  nurses  wish  to  feed  the  child  during  the 
first  day  or  two  of  life  with  sweetened  water,  gruel,  or 
other  substances.  This  is  usually  totally  unnecessary, 
and  is  often  harmful.  If  the  child  really  seems  to  be 
ravenously  hungry,  as  shown  by  the  avidity  with  which 
it  grasps  the  nipple  and  the  cries  which  it  persistently 
utters,  it  may  be  given  a  very  little  cow's  milk  prepared 
according  to  the  method  to  be  considered  later;  but  such 
a  necessity  rarely  arises.  Often  a  little  moderately  hot 
water  will  satisfy  the  child  perfectly.  During  the  first 
two  days  of  life  the  infant  may  be  put  to  the  breast  from 


I  1 8  THE    CARE    OF   THE   BAB  Y. 

four  to  six  times  in  the  twenty-four  hours  ;  after  this, 
during  the  first  six  weeks  of  life,  it  should  be  nursed 
regularly  every  two  or  two  and  a  half  hours  during 
the  day,  and  from  this  up  to  the  time  of  weaning 
every  three  or  four  hours.  It  should  be  trained  as 
far  as  possible  to  do  without  nursing  at  night — from 
ten  in  the  evening  to  early  in  the  morning.  The 
tables  given  on  pages  134  and  135  for  guidance  in  the 
frequency  of  the  feeding  of  bottle-babies  apply  equally 
to  those  nursed  at  the  breast.  Too  much  stress  can- 
not be  laid  on  the  importance  of  regularity  in  nurs- 
ing. No  fault  is  more  common  and  more  pernicious 
than  that  of  suckling  a  child  every  time  it  cries,  and 
simply  for  the  sake  of  quieting  it.  The  temptation  to  do 
this  is  great,  it  is  true,  but  the  final  results  are  evil,  for 
the  baby's  digestion  is  almost  sure  to  suffer,  and  its  dis- 
position to  cry  to  become  worse  and  worse.  IMoreover,  a 
baby  is  to  a  wonderful  degree  a  creature  of  routine,  and 
when  once  it  becomes  a  "slave  to  bad  habits"  it  will 
make  everyone  connected  with  it  a  slave  to  itself  It 
should  never  be  allowed  to  go  to  sleep  at  the  breast  with 
the  nipple  in  its  mouth,  but  should  be  kept  awake  until 
it  has  finished  or  else  be  removed  entirely.  By  the  time 
of  the  next  nursing  it  will  be  hungry  enough  to  keep 
awake.  If  the  baby  is  asleep  when  the  hour  for  nursing 
comes,  it  should  be  aroused  and  fed. 

It  is  a  great  mistake  to  suppose  that  every  cry  that 
stops  temporarily  when  the  breast  is  given  denotes 
hunger.  Often  the  child  is  thirsty,  and  a  little  water  is 
really  what  it  needs.  This  necessity  of  giving  the  baby 
water  is  very  commonly  forgotten.  A  nursing  infant 
should  have  water  offered  to  it  .several  times  a  day,  at 
first  from  a  teaspoon  and  soon  from  a  glass  or  a  nursing- 
bottle.     The  use  of  the  bottle  has  the  advantas-e  that  the 


FEEDING    THE   BABY.  II9 

baby  grows  accustomed  in  this  way  to  its  use,  and  the 
process  of  weaning  later  is  rendered  easier.  Unless  the 
purity  of  the  water  is  beyond  suspicion,  it  should  be  boiled 
and  then  cooled.  So,  too,  the  stopping  of  a  cry  by 
nursing  may  occur  because  the  entrance  of  the  warm 
milk  into  the  stomach  temporarily  relieves  pain — only, 
of  course,  to  increase  the  indigestion  and  to  give  worse 
colic  presently. 

The  mother  also  suffers  from  too  frequent  nursing,  for 
not  only  is  she  then  at  the  mercy  of  the  child's  habits,  but 
she  is  extremely  liable  to  develop  cracked  nipples  as  the 
result  of  the  constant  moistening. 

The  baby  while  nursing  from  the  left  breast  should  be 
held  on  its  right  side  with  its  head  sup|)orted  by  the  left 
arm  of  the  mother.  The  mother  should  be  propped  slightly 
in  bed  with  a  pillow  or  should  lie  upon  her  side.  After  her 
convalescence  she  should  lean  a  little  forward  while  nurs- 
ing, so  that  the  nipple  points  somewhat  downward  toward 
the  child's  mouth,  and  should  slightly  steady  and  elevate 
the  breast  with  the  first  two  fingers  of  the  right  hand  to 
keep  the  weight  from  pressing  upon  its  nose.  If  the  child 
nurses  too  rapidly,  the  nipple  should  be  withdrawn  now 
and  then  to  prevent  its  choking  and  to  allow  it  to 
breathe.  If  the  milk  flows  too  freely  of  itself,  it  may  be 
restrained  by  pressing  the  base  of  the  nipple  between  the 
fingers  and  thumb;  while  if,  on  the  other  hand,  it  does 
not  come  quickly  enough,  and  a  delicate  child  seems 
unable  to  draw  sufficient  nourishment,  the  pressure  of 
the  hand  upon  the  breast  will  aid  in  expelling  it.  In 
nursing  from  the  right  breast  the  position  is  of  course 
reversed,  and  the  child  lies  upon  its  left  side.  In  rare 
instances,  however,  it  will  vomit  if  in  this  position  while 
nursing,  owing  to  the  pressure  of  the  liver  upon  the 
stomach.  In  such  a  case  it  may  lie  upon  its  right  side 
with  its  lesfs  tucked  under  the  mother's  ris^ht  arm. 


120  THE   CAKE    OF  THE   BABY. 

If  there  is  an  abundance  of  milk,  one  breast  is  sufficient 
for  one  nursing,  and  the  baby  empties  it  after  ten  or 
fifteen  minutes,  is  satisfied,  falls  asleep,  and  should  at 
once  be  removed.  The  other  breast  should  be  reserved 
for  the  next  nursing.  The  quantity  of  milk  which  a 
mother  secretes  during  the  first  weeks  of  a  baby's  life  is 
about  one  pint  in  twenty-four  hours.  Later  the  amount 
increases  as  the  needs  of  the  child  grow  greater.  Gener- 
ally the  mother  at  first  has  more  milk  than  a  baby  can 
digest.  A  kind  provision  of  nature  prevents  the  over- 
feeding in  which  a  strong  baby  indulges  from  doing  it 
any  harm,  for  the  stomach  simply  rejects  the  over-sup- 
ply, which  comes  up  just  as  it  went  down.  It  is  not  a 
true,  forcible  vomiting,  such  as  occurs  in  older  infants, 
but  is  a  simple  regurgitation  unattended  by  nausea,  and 
need  give  the  mother  no  immediate  anxiety,  provided 
the  milk  has  no  very  sour  odor  and  the  health  seems 
perfect.  At  the  same  time  the  trouble  should  be  cor- 
rected by  not  allowing  the  baby  to  nurse  quite  so  long  or 
so  often. 

In  this  connection  we  must  consider  the  way  in  which 
a  nursing  mother  ought  to  conduct  her  life,  since  upon 
this  the  health  of  the  baby  will  depend.  Her  diet  is  a 
matter  of  much  importance.  What  she  shall  eat  during 
the  time  she  is  confined  to  bed  will  be  carefully  ordered 
by  her  physician.  It  is  generally  customary  to  alter  the 
diet  to  some  degree,  either  in  quantity  or  in  quality,  since 
the  confinement  to  bed  may  diminish  somewhat  the 
power  of  digestion.  This  is  especially  true  of  the  first 
couple  of  days.  After  the  mother  is  up  and  about 
she  becomes  her  own  mistress  in  this  matter,  and  must 
determine  for  herself  what  is  best  for  her.  She  should 
use  every  means  to  preserve  her  digestion  in  the  very 
best  condition  by  observing  regularity   in   the  time  of 


FEEDING    THE   BABY.  121 

meals,  by  eating  slowly  and  masticating  thoroughly,  and 
\>y  consuming  only  those  things  which  are  digestible  and 
nutritious. 

There  is  a  commonly  prevailing  notion  that  various 
substances  must  be  avoided  because  they  will  give  the 
baby  colic  by  altering  the  milk.  This  is  true  only  to 
a  very  limited  extent,  and  generally  only  in  so  far  as 
the  mother's  digestion  is  disturbed  by  what  she  has 
taken  ;  for  it  is  certain  that  indigestion  in  the  mother, 
by  whatever  means  produced,  is  liable  to  be  followed 
by  indigestion  in  the  child.  It  may  sometimes  happen, 
however,  that  raw  fruit  or  acid  substances  eaten  by 
the  mother  may,  without  affecting  her  digestion  at  all,  in 
some  way  alter  her  milk  and  disagree  with  the  baby;  but 
this  is  rather  the  exception  than  the  rule.  It  is  also  true 
that  such  articles  of  diet  as  onions,  turnips,  cauliflower, 
and  cabbage,  which  have  very  distinct  odors  and  tastes, 
are  sometimes  capable  of  imparting  an  unpleasant  taste 
to  the  mother's  milk,  just  as  cow's  milk  may  taste  dis- 
agreeably of  garlic.  Most  mothers,  however,  who  have 
perfect  digestion  can  eat  nearly  everything  digestible 
without  fear  of  affecting  the  baby. 

It  is  certainly  true  that  there  are  drugs  which,  when 
taken  by  the  mother,  enter  her  milk,  and  it  would  some- 
times be  possible  for  physicians  to  treat  the  child  in  this 
way.  This  is  true  of  some  of  the  purgative  drugs  and 
of  certain  others,  but  even  in  the  case  of  medicines,  as 
with  foods,  most  mothers  may  be,  to  all  intents,  free 
from  anxiety  regarding  the  effect  on  the  baby  of  any 
medicine  that   may  be  prescribed  for  her. 

With  regard  to  the  use  of  stimulants,  the  nursing 
mother  should  follow  her  former  habit  of  life  if  this  has 
been  correct  and  her  health  seems  good.  If  she  is  deli- 
cate or  weak,  she  may  find  stimulants  of  service,  but  the 


122  THE   CARE    OF   THE   BABY. 

advice  of  a  physician  had  better  be  obtained  in  any  case. 
Laro^e  quantities  of  alcoholic  stimulants  taken  by  the 
mother  may  do  the  baby  much  harm. 

Not  infrequently  there  is  an  insufficient  supply  of  milk, 
and  the  question  arises  whether  the  amount  can  be  in- 
creased in  any  way.  The  drinking  of  large  quantities 
of  cow's  milk,  the  use  of  various  milk  foods,  soups,  and 
perhaps  of  malted  liquor  in  some  form,  may  be  of  advan- 
tage. One  of  the  thinner  extracts  of  malt  is  often  use- 
ful. It  must  be  remembered,  however,  that  increasing 
the  secretion  of  milk  does  not  necessarily  increase  ite 
nourishing  jDower,  and  that  to  take  a  large  amount  of 
liquid  nourishment  is  sometimes  only  to  practise  a  de- 
ception upon  the  baby.  It  may  be  merely  following  the 
example  of  the  milkman  who  invokes  the  aid  of  the 
well-pump  ;  for,  although  the  quantity  secreted  may 
be  larger,  the  milk  may  be  more  watery  and  the 
actual  amount  of  nourishment  in  twenty-four  hours 
may  be  just  the  same  as  before.  Still,  much  may  often 
be  done  to  alter  the  character  of  the  milk,  as  we  shall 
see  presently. 

Equally  important  with  proper  diet  is  regular  exercise 
and  the  enjoyment  of  fresh  air,  either  on  foot  or  in  a  car- 
riage. Late  hours  must  be  avoided,  as  must  all  sources 
of  worry,  anxiety,  and  nervous  excitement.  It  is  a  not 
infrequent  occurrence  for  the  milk  secreted  shortly  after 
a  mother  has  experienced  fright,  violent  anger,  or  other 
very  powerful  emotion  to  act  as  an  intense  poison  to  the 
baby.  If  a  mother  has  been  subjected  to  any  such  in- 
fluence, it  is  better  to  empty  the  breast  with  the  pump 
and  to  avoid  nursing  for  a  number  of  hours,  substituting 
artificially  prepared  milk  for  the  time  being. 

The  ability  of  the  mother  to  nurse  her  child  often 
depends  upon  the  condition  of  her  nipples.     They  should 


FEEDING    THE    BABY.  I23 

Iiave  been  attended  to  during  pregnancy,  in  the  manner 
already  described  in  Chapter  I.  In  spite  of  all  efforts, 
however,  the  birth  of  the  child  may  find  the  nipples  unfit 
for  nursing.  Their  shape  may  be  such  that  the  baby  can 
obtain  no  satisfactory  hold,  and  in 
such  a  case  an  artificial  nipple  must 
be  tried.  There  are  many  varieties  of 
these,  but  those  of  the  simplest  con- 
struction should  be  chosen,  as  it  is 
very  necessary  to  keep  them  perfectly 
clean.  One  of  the  best  consists  of 
a  glass  base  upon  which  is  fitted  a 
detachable  rubber  teat  (Fig.  42). 
Such  an  apparatus  may  prove  satis- 
factory, and  the  effort  to  use  it  should        ^'^-  42.-Aitificiai 

1  nipple. 

always  be  made,  but  very  frequently 
a  badly-developed  nipple  will  make  it  necessary  to  aban- 
don nursing. 

To  keep  the  nipples  in  good  condition  a  mother  should 
observe  the  regular  times  for  nursing  as  already  re- 
ferred to,  and  should  invariably  and  immediately  after 
nursing  dry  the  nipples  gently  and  thoroughly  with  a 
soft  cloth,  and  then,  for  the  first  week  or  two,  smear 
them  with  a  little  sweet  oil. 

If  the  nipple  becomes  slightly  raw  or  sore,  it  may  after 
being  dried  have  a  special  bismuth  preparation  applied 
and  allowed  to  remain  (Appendix,  78).  It  is  important, 
too,  to  protect  it  carefully  from  any  friction  of  the  cloth- 
ing, possibly  by  the  use  of  some  form  of  nipple-shield,  if 
the  doctor  sanctions  it.  Before  nursincr  ag^ain  the  bis- 
muth  application  may  be  wiped  away  gently,  but  there 
is  no  need  to  do  this  very  thoroughly,  as  it  is  not  injuri- 
ous to  the  child  if  it  is  swallowed.  The  use  of  an  arti- 
ficial nipple  for  a  few  days  is  to  be  recommended  should 
the  nipple  be  even  only  slightly  sore. 


124  ^'^^^    CAKE    OF   THE   BABY. 

Should  nursing  become  actually  painful,  a  physician 
ought  to  be  consulted  immediately,  for  it  is  much  easier 
to  treat  the  fissures  in  the  early  stages  than  after  they 
have  become  deep.  If  they  are  neglected,  the  pain  of 
nursing  may  become  simply  unendurable. 

Sometimes  the  flow  of  milk  is  so  great  that  even  a 
strong  baby  cannot  manage  to  take  it  all,  and  a  constant 
hard  distention  of  the  breast,  usually  described  as  '  *  caked 
breast  "  or  "milk  cake,"  results.  Unless  this  is  promptly 
relieved  there  is  great  danger  of  an  abscess  forming.  To 
prevent  or  relieve  caking  in  such  cases  the  breast  requires 
long-continued  and  gentle  but  firm  rubbing  with  warm 
sweet  oil  from  the  circumference  toward  the  nipple,  and 
the  occasional  application  of  the  breast-pump  (p.  27)  to 
supplement  the  sucking  by  the  child.  The  mother  must 
on  no  account  fail  to  consult  her  physician  at  once  re- 
garding the  difficulty,  and  should  not  depend  solely  on 
the  ministrations  of  the  monthly  nurse,  as  the  matter  is 
quite  too  serious  for  this. 

Eventually  the  baby  must  be  weaned — that  is,  cease 
entirely  to  receive  human  milk,  and  be  placed  on  a  diet 
of  another  nature.  The  method  of  doing  this  and  the 
age  at  which  it  shall  be  done  vary  somewhat  with  cir- 
cumstances. Some  physicians  advise  that  the  baby 
begin  to  receive  a  small  amount  of  artificial  food  when 
it  reaches  the  age  of  five  or  six  months,  or  even  earlier 
than  this,  on  the  ground  that  its  dependence  upon 
mother's  milk  is  thus  rendered  less  absolute,  and  that  it 
will  not  be  subjected  to  the  dangers  which  sudden  wean- 
ing entails  should  the  milk  of  the  mother  rapidly  dry  up. 
Although  there  is  a  degree  of  truth  in  this,  yet  it  seems 
like  guarding  against  a  possible  danger  by  incurring  a 
very  certain  one — that  of  injuring  the  child's  digestion; 
for  experience  shows  that  there  are  numberless  instances 


FEEDING    THE  BABY.  1 25 

of  severe  illness,  and  even  of  death,  which  have  resulted 
from  the  early  effort  to  replace  mother's  milk  by  cow's 
milk  or  other  food,  no  matter  how  carefully  prepared. 

Yet  there  is  a  mother's  side  to  the  question,  for  there 
is  no  doubt  that  the  feeding  of  her  baby  month  after 
month  from  the  breast  alone  renders  her  life  very  much 
confined  and  is  a  great  drain  upon  her  system,  and  in 
many  instances  her  health,  not  only  immediate  but  fu- 
ture, cannot  endure  it.  In  such  cases,  even  when  there 
is  an  abundance  of  breast-milk,  the  plan  of  giving  one  or 
possibly  two  bottles  a  day  is  to  be  thoughtfully  considered. 
The  substitution,  however,  should  only  be  tried  with  the 
advice  and  under  the  supervision  of  the  family  physician. 
Certainly  the  safest  course  for  a  thriving  baby  is  that  of 
feeding  it  solely  from  the  breast  until  the  age  for  weaning 
comes. 

So,  too,  if  the  baby  ceases  to  grow  at  a  proper  rate, 
and  it  is  proven  that  the  breast-milk  is  insufficient  in 
quantity  or  quality,  the  doctor  may  decide  to  combine 
artificial  feeding  with  nursing. 

Ordinarily,  weaning  should  take  place  at  about  the 
age  of  ten  or  eleven  months.  Longer  nursing  than  this 
is  generally  too  wearing  upon  the  mother,  and  is  also  bad 
for  the  child,  whose  health  is  very  likely  to  be  impaired 
as  a  result  of  the  breast-milk  becoming  thin  and  poor. 
Of  course,  the  exact  age  to  wean  must  depend  on  circum- 
stances. If  the  mother  remain  perfectly  strong  and  the 
baby  continue  in  the  very  best  condition,  it  may  be 
nursed  until  it  is  a  year  old,  while  the  reverse  of  this 
may  make  early  weaning  necessary.  Another  ver}'  im- 
portant matter  is  the  season  of  the  year.  It  is  very  bad 
policy  to  wean  a  child  at  the  beginning  of  hot  summer 
weather  if  it  can  be  avoided  in  any  way.  It  is  certainly 
better  to  defer  it  until  autumn,  and  to  make  up  with 
artificial  food  any  deficiencv  in  the  natural  nourishment. 


126  THE   CARE    OF   THE  BABY. 

Weaning  is  best  done  somewhat  gradually  if  pos- 
sible. At  first  but  one  bottle  a  day  is  given,  the  child 
being  nursed  at  its  other  meals,  but  as  time  goes  on  the 
number  of  bottles  given  is  gradually  increased  while  the 
frequency  of  suckling  is  correspondingly  diminished, 
until  by  the  time  about  a  month  has  elapsed  the  breast 
has  been  withdrawn  entirely.  This  plan  gives  the  child 
time  to  become  accustomed  to  its  new  diet,  which  should 
consist  of  a  milk-mixture  as  much  like  woman's  milk  as 
possible.  The  exact  nature  of  this  will  be  discussed 
presently. 

Sometimes  it  is  necessary  to  wean  rapidly.  One  of  the 
chief  causes  of  this  is  the  refusal  of  the  baby  to  take  the 
bottle  at  all.  Patience  and  persistence  will  generally 
overcome  this,  or  it  may  be  that  the  child  will  take  food 
from  a  spoon  or  a  cup.  Should  it  still  refuse,  the  only 
way  open  is  to  withdraw  the  breast  entirely  and  at  once 
until  hunjrer  forces  the  child  to  eat.  With  sudden  wean- 
ing,  or  sometimes  even  with  the  gradual  process,  the 
mother  has  much  trouble  from  the  distention  of  her 
breasts  with  milk,  and  must  employ  care  lest  an  abscess 
result.  She  should  take  as  little  liquid  of  any  kind  as 
possible,  whether  water,  tea,  soup,  milk,  or  whatever  it 
may  be.  She  should  also  take  a  gentle  purgative,  such 
as  citrate  of  magnesia  or  a  mineral  water,  keep  the 
breasts  supported  by  a  broad  band  going  beneath  them 
and  over  the  shoulders,  partially  empty  them  occasionally 
with  the  breast-pump  if  the  distention  is  painful,  and 
prevent  caking  by  diligently  rubbing  them  with  warm 
oil.  Any  other  treatment,  such  as  the  application  of 
ointments,  had  better  be  left  to  the  family  physician. 

Early  weaning  may  be  rendered  necessary  in  differ- 
ent ways.  If  the  mother  is  suffering  from  the  drain  of 
nursing   or  from  great  debility,   consumption,   or  other 


FEEDING    THE   BABY.  1 27 

exhausting  ailment,  or  if  she  develop  any  severe  acute 
disease,  such  as  typhoid  fever,  pneumonia,  or  the  like, 
nursing  the  child  is  quite  out  of  the  question.  It  is 
very  commonly  believed  that  the  return  of  the  menstrual 
period  makes  nursing  improper.  Although  this  occur- 
rence often  does  render  the  milk  unfit  for  the  child,  yet 
this  is  not  an  invariable  rule,  and  the  mother  should 
do  nothing  precipitately  in  the  matter.  After  the  occur- 
rence of  one  monthly  period  there  may  be  no  reappear- 
ance of  it  for  several  months,  and  weaning  would  have 
been  entirely  unnecessary.  Each  case  is  a  rule  to  itself, 
and  only  the  effect  upon  the  mother  and  baby  can  settle 
the  question,  even  if  the  periods  have  returned  regularly. 

Should  the  mother  become  pregnant  again,  the  child 
should  be  weaned,  for  it  is  too  great  a  drain  upon  her  to 
sustain  both  the  one  present  and  the  one  to  come. 

Sometimes  there  is  a  great  falling  off  in  the  quantity 
or  quality  of  the  milk,  which  cannot  be  remedied  in  any 
way,  or  there  may  be  an  entire  and  even  early  cessation 
of  the  flow.  Again,  the  breast-milk  may  be  richer  than 
the  child  can  digest.  Sometimes  excessively  painful 
fissures  occurring  in  both  breasts  and  refusing  to  heal, 
or  the  persistence  of  obstinately  retracted  nipples,  may 
render  nursing  impossible,  even  with  the  aid  of  an  arti- 
ficial nipple.  Abscess  of  the  breast  prohibits  nursing 
from  the  one  that  is  affected. 

Before  breast-feeding  is  abandoned  on  account  of  any 
defect  in  the  amount  or  quality  of  the  milk  the  mother 
should  not  fail  to  make  sure  that  the  trouble  really  exists, 
and  that  it  cannot  be  remedied.  The  only  accurate 
method  of  determining  the  character  of  the  milk  is,  of 
course,  to  have  a  chemical  analysis  made  of  it.  But  even 
without  this  the  mother  may  be  able  to  form  some  idea 
of  the  nature  of  the  difficulty.     This  is  to  be  done  partly 


128  THE   CARE    OF   THE   BABY. 

by  observation  of  the  baby,  parti)'  by  direct  study  of  the 
milk  with  the  aid  of  a  creamoineter  and  a  specific  gravity 
apparatus,  such  as  are  described  and  their  employment 
explained  on  page  140.  Those  for  use  with  human  milk 
are  usually  made  especially  small,  in  order  that  less  milk 
shall  be  required. 

First,  then,  we  must  remember  that  if  a  baby  is  grow- 
ing at  the  proper  rate,  it  is  getting  enough  to  eat.  Any 
crying  is  probably  due  to  some  other  cause  than  hunger, 
even  although  the  child  may  not  seem  satisfied.  If, 
however,  it  is  not  growing  properly,  and  there  is  no 
diarrhoea,  or  vomiting,  or  other  ailment  to  account  for 
this,  it  is  probable  that  the  milk  either  is  not  rich  enough, 
or  that  it  is  insufficient  in  amount.  If  the  child  tugs 
long  and  hungrily  at  the  breast,  and  is  unwilling  to 
cease  sucking  after  it  should  have  finished,  or  if,  perhaps, 
after  a  period  of  nursing,  it  drops  the  nipple  with  a  dis- 
satisfied cry,  it  is  very  likely  that  the  milk  is  insufficient 
in  quantity.  This  is  particularly  so  if  the  breasts  are 
flabby  before  nursing  and  seem  to  be  quite  empty  after  it. 
If,  on  the  other  hand,  the  milk  is  bluish  and  pale  even 
though  very  abundant,  and  if  the  child  seems  tempo- 
rarily satisfied  after  nursing  and  the  breasts  are  not 
emptied,  it  is  probable  that  the  richness  of  the  milk  is 
deficient. 

By  looking  at  the  analytical  table  on  page  137  we  see 
the  ing^redients  of  which  milk  consists.  It  is  the  fat  and 
the  proteids  (see  page  137)  which  are  the  ones  especially 
liable  to  vary  in  quantity.  The  amount  of  sugar  may  be 
ignored  at  present,  as  it  is  less  variable.  Milk  deficient 
in  richness  may  lack  the  proper  proportion  of  either  or 
both  of  these  two  ingredients.  Which  of  them  is  at  fault 
we  can  determine  to  some  degree  by  direct  study  of  the 
milk.      In  getting  the  milk  for  examination  the  baby 


FEEDING    THE  BABY.  1 29 

should  be  allowed  to  nurse  for  a  couple  of  minutes,  the 
nipple  should  then  be  washed  and  dried  carefully,  and  a 
portion  (about  one  or  two  tablespoonfuls)  should  then  be 
drawn  by  the  breast-pump.  It  should  be  put  into  a 
bottle  and  kept  directly  on  the  ice.  At  later  nursings 
similar  small  amounts  may  be  procured  and  added  to  the 
first.  The  milk  thus  obtained  represents  the  average  of 
about  the  middle  of  the  nursings. 

Average  human  milk  should  separate  in  the  cream- 
ometer  about  7  per  cent,  of  cream,  which  is  equivalent 
to  about  4  per  cent,  of  fat.  By  determining  the  percent- 
age of  cream  with  this  instrument  and  comparing  it  with 
the  specific  gravity  we  can,  as  we  shall  see  presently, 
estimate  the  amount  of  proteids  present,  and  decide 
whether  the  lack  of  richness  is  in  fat  or  in  proteids,  or  in 
both  (see  Table,  page  130). 

But  very  often  the  necessity  of  weaning  threatens  on 
account  of  an  excess  of  richness  of  the  milk.  An  excess 
in  the  actual  quantity  of  the  milk  may  show  itself  by  re- 
gurgitation (see  pages  130  and  269)  and  often  by  the 
presence  of  large  quantities  of  curds  in  the  stools.  This 
excess  is  generally  easily  controlled  by  removing  the 
child  from  the  breast  before  it  has  taken  too  much,  or  by 
compressing  the  nipple  during  the  nursing  in  order  to 
make  the  milk  flow  more  slowly.  Too  great  richness  of 
the  milk  is  not  so  easily  managed.  If  there  is  too  much 
fat  present,  there  may  be  a  tendency  to  vomit  rancid- 
smelling  material,  or  to  suffer  from  diarrhoea.  The  test 
with  the  creamometer  will  show  the  actual  amount  of 
cream.  By  far  the  more  frequent  and  troublesome  fault, 
however,  is  an  excess  of  the  proteids.  This  usually 
shows  itself  by  vomiting  of  curdy  material,  or,  still 
oftener,  by  the  constant  presence  of  a  large  amount  of 
white,  curdy  lumps  in  the  stools.  Except  b}'  the  ex- 
9 


130 


THE   CARE    OE   THE   BABY. 


aiiiiiiatiou  of  the  milk,  this  condition  can  scarcely  be  dis- 
tinguished from  the  disordered  stools  dependent  upon  an 
excessive  quantity  of  milk  taken.  Colic,  too,  is  very 
common,  and  all  the  symptoms  of  indigestion  may  finally 
grow  so  prominent  that  weaning  may  seem  necessary. 
Again  by  the  use  of  the  creamometer  we  may  determine 
the  amount  of  cream  present,  and  then,  by  comparing 
this  with  the  specific  gravity,  we  can  judge  whether  the 
proteids  are  in  excess. 

The  following  very  useful  table  has  been  devised 
(Holt),  by  consulting  which  the  mother  may  be  aided  in 
making,  with  a  little  practice,  an  approximate  analysis 
of  her  breast-milk.  The  procedure  is  quite  simple.  The 
specific  gravity  of  a  sample  of  milk  is  obtained  at  the 
ordinary  room  temperature  of  70°  F.  The  cream  per- 
centage is  read  off  after  the  milk  has  stood  in  the  cream- 
ometer for  twenty-four  hours.  If  these  two  are  now 
compared,  as  found  in  the  second  and  third  columns  of 
the  table,  the  amount  of  proteids  corresponding  to  these 
will  be  shown  in  the  fourth  column.  At  the  same  time 
it  is  certainly  better,  as  a  rule,  to  leave  this  analysis  to 
some  one  experienced  in  such  matters. 

Approximate  Anai^ysis  of  Breast-milk. 


Average. 

Normal  variations. 


Abnormal 


Specific  Gravity. 
70°  Fahr. 


1031. 

102 8-1029. 

1032-1033. 

Low  (below  1028). 


High  (above  1033) 


Cream,  Twenty-four 
Hours. 


7  per  cent. 
8-12  per  cent. 
5-6  per  cent. 

High  (above  10  percent.). 
Normal  (5-10  per  cent.). 
Low  (below  5  per  cent.). 
High  (above  10  per  cent.) . 
Normal  (5-10  per  cent.). 
Low  (below  5  per  cent.). 


Proteids. 


1.5  per  cent. 
Normal  (rich  milk). 

"        (fair  milk). 

"        or  slightly  below. 
Low  (poor  milk). 
Very  low  (very  poor  milk). 
"   high  (very  rich  milk). 
High  (rich  milk). 
Normal,  or  nearly  so. 


Supposing,   now,   that  we  have  found  some  defect  in 
the  quantity  or  quality  of  the  breast-milk.     The  ques 


FEEDING    THE  BABY.  I31 

tion  arising  is  whether  something  cannot  be  done  to  cor- 
rect this,  instead  of  at  once  subjecting  the  baby  to  the 
trials  of  artificial  feeding.  Modification  of  the  amount  or 
kind  of  food  taken,  and  of  the  method  of  living  and  the 
frequency  of  nursing,  exerts  a  powerful  influence  upon 
the  composition  of  the  milk.  Consequently  much  may 
often  be  accomplished  by  following  certain  rules,  which 
are  formulated  in  the  following  table  (Rotch). 

Rules  for  Modifying  Breast-milk. 

^    .  ^1     ^  ^  1  ^-^        f  Increase    the    liquids    in    the 

To  increase  the  total  quantity  .    -j  , . 

^    J  ,...   .  .-.         (  Decrease    the    liquids    in    the 

To  decrease  the  total  quantity  .   -j  , .  ^ 

{Shorten    nursing-intervals  ;  de- 
crease    exercise  ;     decrease 
the  liquids   in  the  diet. 
C  Ivcngthen  nursing-intervals  ;  in- 
To  decrease  the  total  solids  .   .  <         crease     exercise ;     increase 

(,         the  liquids   in   the  diet. 

To  increase  the  fat Increase  the  meat  in  the  diet. 

To  decrease  the  fat Decrease  the  meat  in  the  diet. 

To  increase  the  proteids  ....       Decrease  the  exercise. 

^     ,  ,  . .  f  Increase    the    exercise    to    the 

To  decrease  the  proteids.    .    ..   |         ^.^.^  ^^  ^.^^.^^^ 

The  expression  "  total  solids"  means  the  total  amount 
of  fat,  proteids,  sugar,  and  salts  of  the  milk. 

Should  the  mother  still  find  it  necessary  to  abandon 
nursing,  she  does  not  necessarily  have  to  wean  the  baby, 
since  she  may  employ  a  wet-nurse.  There  is  no  question 
that  the  milk  of  a  good  wet-nurse  is  very  greatly  to 
be  preferred  to  bottle-feeding.  At  the  same  time  there 
are  many  and  weighty  objections  to  the  employment  of 
a  wet-nurse.  Not  only  is  it  very  diflficult  to  obtain  one 
who  even  seems  likely  to  be  suitable,  but  the  position  of 


132  THE   CARE    OF   THE  BABY. 

the  nurse  at  once  makes  her  the  tyrant  of  the  household. 
She  frequently  proves  to  be  altogether  unreliable,  will  not 
take  the  care  of  herself  which  is  necessar)'  to  the  preser- 
vation of  the  quality  of  her  milk,  and  at  any  moment 
may  become  dissatisfied  and  abandon  her  position,  per- 
haps leaving  the  last  state  of  the  baby  considerably 
worse  than  the  first.  Nevertheless,  in  the  case  of  a  deli- 
cate child  or  the  failure  of  artificial  food  to  agree,  the 
employment  of  a  wet-nurse  often  is  the  baby's  only 
chance  for  life.  I  have  often  seen  really  remarkable  re- 
sults quickly  follow  the  employment  of  a  wet-nurse  for  a 
child  who  had  failed  to  improve  at  all  on  artificial  feed- 
ing. The  selection  of  a  w^et-nurse  we  can  best  discuss 
when  considering  the  subject  of  The  Baby's  Nurses,  in 
Chapter  IX. 

This  brings  us  to  the  consideration  of  the  very  compli- 
cated subject  of  ^^r/^^Vz/ y^^'^m^,  often  one  of  the  most 
perplexing  problems  which  can  present  itself  to  the  com- 
bined study  of  mother  and  physician.  In  the  eflfort  to 
solve  it  too  careful  attention  cannot  be  paid  to  the 
smallest  and  apparently  most  trifling  details,  for,  although 
many  a  baby  seems  to  have  a  totally  insensitive  stom- 
ach and  will  thrive  on  nearly  anything,  many  another 
cannot  keep  in  health  unless  the  food  suits  it  exactly. 
In  endeavoring  to  feed  a  baby  properly  w^e  must  bear  in 
mind  three  important  factors,  already  referred  to  to  some 
extent  in  discussing  the  means  of  modifying  the  breast- 
milk: 

(i)  The  quantity  of  the  food; 

(2)  The  quality  of  the  food; 

(3)  The  individual  peculiarities  of  the  child. 

(i)  The  Quantity  of  the  Food. — One  of  the  most  fre- 
quent mistakes  made  in  feeding  a  baby  is  that  of  giving 
it  a  much  greater  quantity  of  food  than  it  can  possibly 


FEEDING    THE   BAnV.  I  33 

assimilate,  with  the  result  that  it  either  vomits  it  or 
passes  it  through  the  bowels  in  an  undigested  state.  A 
new-born  baby's  stomach  holds  without  distention  only 
about  one  ounce  (two  tablespoonfuls)  or  less.  The  ac- 
companying illustration  (Fig.  43)  represents  the  actual 
size  of  the  stomach  at  birth.  It  shows  perhaps  better 
than  in  any  other  way  how  small  the  infant  stomach 
really  is.     How  foolish,  then,   to  feed  a  new-born  child 


Fig.  43. — Stomach  of  infant  at  birth  (natural  size). 

from  a  full-sized  nursing  bottle,  and  to  allow  it  to  gorge 
itself  with  all  it  will  take!  Careful  study  of  the  size  of 
the  stomach  at  different  ages  in  infancy,  and  of  the 
quantity  of  milk  drawn  from  the  breast  by  a  nursing 
baby,  has  led  to  pretty  uniform  conclusions  among  physi- 
cians regarding  the  amount  of  nourishment  which  may 
be  suitably  given  to  a  child  at  different  periods  of  its 
life.  The  accompanying  table,  taken  with  slight  modifi- 
cations from  an  excellent  article  by  Dr.  Rotch,  shows  the 
amount  proper  at  each  feeding,  the  number  of  feedings, 
and  the  total  quantity  required  in  twent3'-four  hours. 
As  has  been  stated  in  a  previous  chapter,  this  and  the 


134 


THE   CARE    OF   THE  BABY. 


following  tables  apply  as  well  to  children  who  are  fed  at 
the  breast,  and  may  be  taken  as  a  guide  for  the  frequency 
of  and  hours  for  nursing^  them. 


General  Rules  for  Feeding. 


Age. 

Intervals  of 
feeding. 

Number  of 

feedings  in 

24  hours. 

Number  of 

feedings   at 

night  after  10 

P.M.  (between 

10  and  7). 

Amount  at 
each  feeding. 

Total  amount 
in  24  hours. 

I  to  4  weeks. 

2  hours. 

10 

2 

I  to  2 

ounces. 

10  to  20 
ounces. 

4  weeks  to 
3  months. 

2^  hours. 

8 

I 

2>^tO 

4  ounces. 

20  to  32 
ounces. 

3  months  to 
4  or  5  months. 

3  hours. 

7 

I 

4  to  5 
ounces. 

28  to  35 
ounces. 

4  or  5  months 
to  I  year. 

3  hours. 

6 

0 

5  to  8 

ounces. 

30  to  48 
ounces. 

As  already  stated  on  p.  117,  during  the  first  two  days 
of  the  first  month  the  child  is  not  given  the  breast  more 
than  from  four  to  six  times  in  twenty-four  hours.  Some- 
times it  is  better  after  the  ninth  or  tenth  month  to 
lengthen  the  intervals  to  three  and  a  half  hours,  making 
five  feedings  in  twenty-four  hours. 

The  above  table  is  intended  to  apply  only  to  children 
of  the  normal  lengths  and  weights  corresponding  to  their 
ages,  and  is,  like  all  rules,  subject  to  exceptions.  It  is 
important  that  the  size  of  a  child  be  constantly  borne  in 
mind,  since  it  is  often  more  of  a  criterion  than  the  age. 
It  is  manifestly  absurd  to  expect  a  baby  twice  as  large  as 
another  of  the  same  age  to  be  contented  with  the  amount 
of  food  which  satisfies  the  smaller  one.  When,  there- 
fore, a  baby  has  largely  fallen  behind  in  growth,  we  must 
often  ignore  its  age  to  a  great  extent,  and  give  to  it  an 
amount  of  nourishment  not  much  in  excess  of  that  suit- 


FEEDING    THE  BABY. 


135 


able  to  the  age  to  which  its  actual  size  and  weight  cor- 
respond. This  age  may  be  determined  by  consulting  the 
table  on  page  53.  On  the  other  hand,  some  children  take 
and  digest  much  more  food  than  others  of  equal  age  and 
equal  size.  In  such  cases  it  is  safe  to  exceed  the  amount 
given  in  the  table  if  we  are  quite  sure  the  food  is  being 
digested. 

The  following  table  gives  in  convenient  form  the  hours 
for  feeding  a  child  under  one  year  of  age,  whether  on  the 
bottle  or  at  the  breast.  It  is  made  to  correspond,  as  far 
as  possible,  with  the  table  just  given,  and  is  so  arranged 
that  feeding  does  not  interfere  with  the  hours  for  the 
morning  and  afternoon  naps. 


Hours  for  Feeding. 


I  to  4  weeks. 

4  weeks  to  3  months. 

3  months  to  4  or  5 
months. 

4  or  s  months  to 
I  year. 

7  A.M. 

7          A.M. 

7  A.M. 

7  A.M. 

9       " 

9-30       " 

10      " 

10      " 

II       " 

12   M. 

I  P.M. 

I  P.M. 

I  P.M. 

2.30  P.M. 

4      " 

4     " 

3    " 

5 

7     " 

7     " 

5    " 

7.30    " 

10     " 

10     " 

7    " 

10         " 

3  A.M. 

9    " 

3         A.M. 

12    " 

4  A.M. 

This  table,  like  the  preceding,  is,  of  course,  intended 
only  as  a  guide,  not  as  a  hard-and-fast  rule.  It  is  open 
to  modification  depending  upon  various  factors.  It  is 
often  better  to  begin  the  day's  feeding  at  six  instead  of 
seven.  This  advances  all  the  feedings  one  hour,  and 
makes  the  early  evening  nursing  less  likely  to  interfere 
with  the  hour  for  going  to  bed.  Some  children  with 
healthy  appetites  do  not  require  or  desire  nursing  so  fre- 
quently.    If  an  interval  of  three  and  a  half  or  four  hours 


136  THE   CAKE   OF  TJIE  BABY. 

is  adopted  at  the  age  of  nine  or  ten  months,  the  hours 
for  feeding  will  read  7  and  10.30  a.m.,  and  2,  6,  and 
9  P.M.  If  the  baby  is  fonnd  generally  to  be  asleep  at 
one  or  more  of  the  feeding  hours,  it  should  either  be 
awakened  and  fed,  or  some  lasting  alteration  in  the 
schedule  made.  Usually  the  child  soon  learns  to  wake 
of  its  own  accord  at  the  proper  time.  Again,  if  a  child 
wakens  hungry  every  night  at  a  time  different  from  that 
given  in  the  table,  it  is  better  to  feed  it  then  than  to 
allow  it  to  rouse  itself  thoroughly  by  crying.  A  very 
important  factor,  too,  especially  in  later  infancy,  is  the 
convenience  of  the  mother,  and  the  hours  for  meals  for 
the  household  in  general.  Regularity  is,  after  all,  the 
principal  matter. 

(2)  The  Quality  of  the  Food. — Regarding  the  char- 
acter of  food  to  be  given  to  a  child — that  is,  its  quality — 
it  is  evident  that  the  more  closely  the  food  resembles 
mother's  milk,  the  more  likely  it  is  to  agree  with  the 
child.  It  is  a  common  custom  to  alter  the  composition 
of  the  artificially  prepared  milk  according  to  the  increas- 
ing age  of  the  child.  To  make  this  a  routine  procedure, 
in  the  case  of  healthy  and  flourishing  babies,  is  unneces- 
sary and  harmful.  The  mother's  milk,  if  it  keeps  of 
good  quality,  does  not  vary  very  materially  during  the 
many  months  of  suckling,  and  consequently  no  necessity 
exists  for  any  change  in  the  composition  of  the  artificial 
food  if  we  can  once  get  it  to  simulate  human  milk  and 
to  be  well  digested.  It  is  perfectly  true  that  many  in- 
fants do  need  progressive  increase  in  the  strength  of  the 
mixture  as  they  grow  older.  Many,  on  the  other  hand, 
are  injured  by  attempting  to  give  stronger  food.  The 
whole  matter  is  an  individual  one.  If  a  child  ceases  to 
grow  properly  yet  has  no  illness,  stronger  food  is  usually 
needed.     Just   how   strong   the   baby's   physician   must 


FEEDING    THE  BABY- 


137 


determine.  The  milk  both  of  the  ass  and  of  the  mare  is 
considerably  closer  in  composition  to  human  milk  than 
is  that  of  other  domestic  animals.  That  of  the  goat  is 
more  like  that  of  the  cow.  It  is  rare,  however,  that  either 
of  the  first  two  milks  can  be  obtained,  and  they  are  apt 
to  be  expensive  ;  and  since  all  of  them  need  in  any  case 
to  be  prepared  in  various  ways  before  using,  cow's  milk 
becomes  the  only  baby-food  usually  practicable.  That  it 
is,  however,  much  unlike  woman's  milk  in  some  particu- 
lars can  be  seen  by  consulting  the  following  table,  which 
gives  approximate  analyses  of  the  two  fluids. 


Woman's  Milk. 

Cow's  Milk. 

Reaction  ...... 

Bacteria 

Water 

Total  solids    .... 
Fat 

.  Alkaline 
.  Absent 

.  87-88% 
•  12-13% 

4% 
.  1-1.5% 

.7% 
0.2% 

Reaction 

Bacteria 

Water 

Total  solids      .... 
Fat      

.  Acid. 
.  Present. 
.86-87% 

•  13-14% 

.  45^ 

Proteids   

Milk-sugar     .... 
Asii 

Proteids     

Milk-sugar 

Ash 

-4% 
•  4-5% 
.  0.7% 

The  specific  gravity  of  woman's  milk  does  not  differ 
materially  from  that  of  cow's  milk,  the  normal  range 
being  from  1028  to  1033.  Cow's  milk  is,  as  the  table 
shows,  slightly  acid  in  reaction  in  the  condition  in  which 
it  is  served  by  the  milkman.  As  drawn  from  the  cow  it 
ought  to  be  alkaline,  but  it  very  quickly  becomes  acid, 
owing  to  faults  in  the  milking  and  exposure  to  air. 
When  we  consult  the  table  we  are  struck  by  the  fact 
that  woman's  milk  has  the  same  percentage  of  fat  as 
cow's  milk,  that  it  is  almost  twice  as  rich  in  sugar,  and 
that  it  has  only  one-quarter  as  much  of  the  "proteids." 
By  this  last  term  is  designated  that  nitrogenous  portion 
of  the  milk  upon  which  the  production  of  new  tissue  in 


138  THE   CARE    OF   THE  BABY. 

the  baby  largely  depends.  Prominent  among  the  milk 
proteids  is  the  casein — namely,  the  part  which  forms  the 
curd.  This  casein  is  particularly  abundant  in  cow's 
milk,  and  it  is  this  ingredient  especially  which  renders 
the  pure  milk  of  the  cow  unfit  for  the  baby.  Now,  if 
we  dilute  cow's  milk  with  water  sufficiently  to  render 
the  percentage  of  proteids  identical  with  that  of  human 
milk,  we  shall  meantime  lower  the  amount  of  sugar  and 
of  fat,  and  the  milk  will  be  very  weak  in  these  ingre- 
dients. The  only  method  by  which  to  overcome  the 
difficulty  is  to  make  up  the  deficiency  after  dilution  by 
adding  more  cream  and  sugar.  Besides  this,  we  must 
add  to  the  mixture  a  small  quantity  of  an  alkali,  such 
as  lime-water  or  bicarbonate  of  soda,  in  order  to  neutral- 
ize the  slight  acidity. 

Another  characteristic  of  cow's  milk  is  the  fact  that 
the  curd  which  forms  in  it  is  much  tougher  and  firmer 
than  that  which  is  seen  in  woman's  milk.  This  may  be 
due  to  some  chemical  peculiarity  of  the  casein,  but  it 
seems  more  likely  to  be  dependent  chiefly  upon  the 
greater  amount  of  it  present.  Casein  is  not  the  only 
proteid  of  milk.  Another  is  "  lactalbumin,"  which  is 
much  more  abundant  in  human  milk,  and  is  much 
easier  of  digestion  than  the  casein.  It  is  these  and 
probably  other  little  understood  differences  in  the  two 
sorts  of  milk  which  account  for  the  difficulty  many  chil- 
dren experience  in  thriving  upon  anything  but  human 
milk. 

It  has  been  claimed,  too,  that  boiling  causes  the  form- 
ation of  a  tougher  curd,  and  it  is  probable  that  it  does  alter 
the  milk  in  some  way  which  may  render  it  rather  more 
difficult  to  digest. 

Although  there  are  numbers  of  infant's  foods  on  the 
market,  as  a  rule  by  far  the  safest  and  most  accurate  sub- 


FEEDING    THE   BABY.  1 39 

stitute  for  mother's  milk  can  be  prepared  at  home.  To 
make  the  mixture  properly  it  is  of  primary  importance  that 
the  several  ingredients  themselves  be  of  proper  quality. 
The  cow's  milk  should  be  unskimmed  and  should  be  pro= 
cured  from  a  reliable  dealer  whose  cows  are  healthy  and 
carefully  kept,  and  are  not  fed  upon  swill  or  other  refuse 
material.  It  is  of  no  advantage  to  have  the  milk  from  a 
single  cow;  it  is,  in  fact,  of  distinct  disadvantage,  for  the 
great  difference  which  exists  between  the  milk  of  differ- 
ent cows  makes  it  impossible  to  prepare  a  proper  imita- 
tion of  mother's  milk  according  to  any  fixed  rule  unless 
we  should  have  the  individual  cow's  milk  analyzed  in 
order  to  determine  exactly  what  its  strength  is.  Besides 
this,  the  milk  of  any  cow  is  subject  to  variations  from 
time  to  time,  depending  upon  the  nature  of  the  food 
given  it,  the  health  of  the  animal,  and  other  factors. 
It  is  therefore  preferable  to  use  mixed  herd  milk — not 
solely  Jersey,  which  is  too  rich — since  this  gives  a  much 
more  uniform  basis  for  the  food. 

Every  possible  precaution  should  be  taken  to  ensure 
absolute  cleanliness  of  the  udder,  the  milk  pail,  and  the 
hands  during  milking,  and  the  milk  should  then  be 
cooled  rapidly  and  at  once  sealed  in  jars.  We  can  judge 
to  a  large  extent  of  the  quality  of  the  milk  by  its  appear- 
ance. It  should  be  of  a  yellowish-white  color,  without 
any  bluish  tinge.  To  determine  still  more  accurately 
its  quality  an  instrument  called  a  lactometer  \s  employed, 
although  the  simplest  apparatus  is  the  urinometer,  used 
by  physicians  for  testing  urine.  This  latter  apparatus, 
which  may  be  procured  through  any  druggist,  consists 
of  a  small  glass  cylindrical  tube  and  a  specific-gravity 
glass,  as  shown  in  the  illustration  (Fig.  44).  The  tube 
should  be  partially  filled  with  milk  of  the  usual  room- 
temperature  (70°  F.)  and  the  glass  be  floated  in  it.     The 


140 


THE    CAKE    OF   77/ E  BABY. 


Fig.  44. — Urin- 
ometer. 


Fig.  45.— 
Creamometer. 


specific  gravity  of  the  milk — that  is,  its  density  as  com- 
pared with  water — may  then  be  read  off  on  the  scale  on 

the  stem  of  the  apparatus.       Taking  the 

density  of  water  as  1000,  that  of  cow's  milk 
should  average  1029  ^^  1030,  with  a  normal 
range  of  from  1028  to  1033. 
Yet  the  apparatus  is  of  lim- 
ited value  only,  for  under  cer- 
tain circumstances  milk  which 
is  poor  may  show  a  specific 
gravity  identical  with  that  of 
milk  which  is  rich.  All  that 
we  can  say  here  is,  that  if  the 
.specific  gravity  is  less  than 
1028  or  more  than  1033,  the 
milk  is  su.spicious.  Of  course, 
even  a  normal  specific  gravity,  taken  by  itself,  is  not 
proof  that  the  milk  is  good. 

So,  too,  there  is  no  accurate  instrument  for  household 
use  which  shows  the  richness  of  the  milk  in  cream.  An 
inexpensive  apparatus  called  a  creaniojjieter  or  cream 
gauge  is  sold  in  the  instrument-shops  and  is  often  recom- 
mended. It  consists  of  a  cylindrical  tube,  all,  or  the 
upper  part,  of  which  is  graduated.  The  milk  is  allowed 
to  stand  in  this,  carefully  corked,  for  twenty-four  hours, 
at  about  70°  Fahr.,  until  the  cream  rises,  and  the  thick- 
ness of  the  layer  of  the  latter  is  then  read  off  on  the  scale 
(Fig.  45)  Theoretically,  the  cream  in  the  apparatus 
should  measure  1  or  jL-  of  the  total  height  of  the  column. 
The  trouble  with  the  creamometer,  however,  is  that  some 
milk,  even  though  rich,  parts  with  the  cream  very  slowly 
and  imperfectly,  while  some  poor  milk  allo\vs  nearly  all 
of  it  to  go  to  the  surface.  The  results  with  the  appa- 
ratus are  consequently  very  misleading,  for  the  poor  milk 


FEEDING    THE  BABY.  141 

may  seem  to  have  more  cream  than  the  rich.  I  know,  in 
fact,  of  no  way  for  the  mother  to  determine  the  amount 
of  cream  except  roughly  by  the  color  and  richness  in  ap- 
pearance of  the  milk.  Where  the  milk  seems  even  sus- 
picious the  milkman  should  be  changed.  In  cities  it  is 
easy  to  have  an  analysis  of  the  milk  made  by  a  chemist. 
The  use  of  the  creamometer  for  testing  human  milk  is 
rather  more  satisfactory.  It  has  already  been  described 
on  page  129. 

There  is  one  test  which  we  can  always  apply — namely, 
that  for  acidity.  A  strip  of  blue  litmus-paper  dipped  part 
way  into  the  milk  will  turn  faintly  red  if  this  is  acid, 
as  it  nearly  always  is  when  delivered  by  the  milkman. 
The  milk  should  be  put  in  the  tube  of  the  urinometer, 
and  the  paper  examined  through  the  glass  while  still  in 
the  milk.  If,  after  the  mixing  with  lime-water  or  soda- 
solution,  and  the  sterilizing,  presently  to  be  described, 
we  again  find  that  blue  litmus-paper  turns  red,  we  know 
that  the  milk  is  becoming  sour  and  is  unfit  for  use. 

Milk  is  often  artificially  colored  to  give  it  a  rich  creamy 
appearance.  The  substance  oftenest  used  for  this  purpose 
is  annatto.  It  may  be  detected  by  mixing  a  pinch  of 
baking-soda  with  a  couple  of  tablespoonfuls  of  the  milk, 
inserting  one-half  of  a  strip  of  filter-paper  in  the  fluid, 
and  allowing  it  to  remain  over  night.  Annatto  will  give 
a  distinct  orange  tint  to  the  immersed  paper. 

Various  substances,  such  as  boric  acid,  salicylic  acid, 
or  formaldehyde,  are  often  used  by  dealers  to  preserve 
the  milk.  As  the  mother  is  unable  to  discover  the  adul- 
teration, she  is  only  made  safe  by  choosing  some  entirely 
reliable  dairy,  or  by  having  the  milk  examined  by  a 
chemist. 

The  choice  of  the  cream  which  is  to  be  added  in  mak- 
ing the  baby's  food  is  of  importance,    since   it   varies 


142  THE    CARE    OF   THE   BABY. 

greatly  in  richness.  To  be  accurate  a  chemical  analysis 
is  needed.  For  practical  purposes  it  is  chiefly  important 
to  consider  how  the  cream  is  obtained — whether  by  skim- 
ming or  by  a  centrifugal "  machine  such  as  is  u.sed  in  the 
large  dairies.  The  thinner  centrifugal  cream,  about  as 
thin  as  a  machine  makes  it,  is  to  be  preferred.  It  con- 
tains about  20  per  cent,  of  fat,  while  the  average  cream 
obtained  by  skimming  possesses  about  16  per  cent,  of  fat. 
It  is  better  to  obtain  the  centrifugal  cream  when  possible, 
as  its  richness  is  more  uniform,  and,  besides  this,  it  is  not 
so  apt  to  have  undergone  changes  as  a  result  of  the  long 
standing  to  which  ordinary  cream  is  subjected.  When 
skimmed  cream  must  be  used,  instructions  should  be 
given  to  the  dairyman  that  the  milk  stand  always  the 
same  number  of  hours,  and  at  the  same  temperature, 
before  skimming,  and  that  it  always  be  skimmed  by  the 
same  person.  The  mother  may,  if  she  wishes,  "set" 
the  cream  herself,  dipping  or  syphoning  it  off  as  de- 
scribed for  "top  milk"  (p.  145).  The  amount  of  cream 
used  in  preparing  the  bottle  will  depend  entirely  upon 
its  percentage  of  fat,  since  the  richer  it  is  the  less,  of 
course,  will  be  required.  Very  often  the  quantity  can 
be  determined  solely  by  experience  in  feeding  the  child. 
As  in  the  case  of  milk,  it  is  better  that  the  cream  come 
from  a  herd  rather  than  from  one  cow. 

Although  ordinary  sugar  (cane-sugar)  may  be  used  to 
sweeten  the  baby's  food,  it  is  better  to  employ  milk-sugar, 
since  this  is  the  variety  naturally  present  in  milk.  Cane- 
sugar  answers  just  as  well  for  sweetening,  but  it  is  prob- 
able that  the  milk-sugar  serves  some  other  purpose  than 
this  merely.  Should  it  be  desired  for  any  reason  to 
use  cane-sugar,  it  is  important  to  remember  that  it  has 
a  greater  sweetening  power  than  milk-sugar,  and  should 
be  used  in  about  half  the  amount. 


FEEDING    THE   BABY.  1 43 

Some  physicians  recommend  that  a  pinch  of  salt  be 
added  to  the  mixture  in  order  to  make  up  for  the  amount 
naturally  in  the  milk  before  the  dilution.  The  addition 
certainly  does  no  harm,  although  it  is  not  an  essential. 

We  are  now  ready  to  examine  the  methods  of  mixing 
our  ingredients  in  order  to  produce  a  suitable  imitation 
of  human  milk.  Various  mixtures  have  been  proposed, 
many  of  them  excellent,  many  very  unsatisfactory.  The 
following  formula  produces  a  milk  mixture  the  propor- 
tions of  which  simulate  fairly  closely  those  of  human 
milk : 

F0RMUI.A  FOR  Milk  Mixture. 

Milk I  oz.  ; 

Cream,  centrifugal  (20  per  cent,  fat)    .    .  iJS^  oz.  ; 

or 
Cream,  skimmed  (16  per  cent,  fat)  .   .    .  2  oz.  ; 

Lime-water >^  oz.  ; 

Milk-sugar i  scant  measure  ; 

Water,  suflScient  to  make   . 8  oz. 

The  amount  of  cream  varies  with  its  richness,  as  indi- 
cated in  the  formula.  Lime-water  is  the  best  alkali  for 
use  in  the  food,  unless  the  mixture  is  to  be  sterilized  at 
a  high  temperature,  in  which  case,  for  reasons  which  we 
shall  consider  presently,  a  solution  of  bicarbonate  of 
soda  may  well  be  substituted  for  it.  This  soda-solution 
is  of  the  strength  of  i  grain  of  bicarbonate  of  soda  in  a 
half  ounce  of  water.  It  will  keep  indefinitely.  A  half 
dozen  or  more  packages,  each  containing  i  drachm  of  the 
soda,  may  be  obtained  from  a  druggist  at  small  cost.  One 
of  these  dissolved  in  a  quart  of  water  forms  a  solution  of 
the  proper  strength,  one  tablespoonful  of  it  equalling  in 
alkalinity  one  tablespoonful  of  lime-water.  It  should  be 
kept  in  a  bottle,  well  corked. 

To  gave   expense,  the   milk-sugar  should  be   bought 


144  ^^^^-    CAKE    OF  THE   BABY. 

several  pounds  at  a  time,  and  from  a  wholesale  druggist. 
The  required  amount  may  be  measured  out  as  needed. 
I  have  had  made  a  small  tin  measure '  holding  half  an 
ounce  of  sugar  (Fig.  46).     The  measure  should  be  filled 


=^^^ 


Fig.  46. — Sugar-measure. 


by  scooping  up  the  sugar  out  of  its  box.  It  should  then 
be  tapped  twice  against  the  table  to  settle  the  contents 
slightly,  and  the  excess  scraped  off  with  a  knife.  The 
sugar  may  then  be  dissolved  in  the  amount  of  water 
which  is  to  be  used  for  the  milk  mixture  for  the  day. 
Heat  may  be  used  if  it  does  not  dissolve  readih'.  The 
solution  should  be  strained  through  cheesecloth  or  raw 
cotton  if  it  is  not  entirely  clear. 

Some  ph}-sicians  advise  having  a  stock  "sugar  solu- 
tion "  of  a  certain  strength  to  be  used  in  making  the 
mixtures.  This  has  to  be  made  very  frequently,  as  it 
will  not  keep  well. 

It  is  often  a  difficult  matter  to  procure  a  satisfacton,-- 
cream.  We  may  then,  in  place  of  the  ordinary  cream, 
use  " /£?/-w?7/l', "  as  it  is  called.  This  may  be  obtained 
as  follows:  Have  made  a  syphon — a  U-shaped  tube — from 
a  piece  of  glass  tubing,  letting  the  short  arm  be  about 
eio^ht  inches  longr  and  the  long^  arm  about  twice  this. 
Procure  in  the  morning  one  quart  of  milk,  place  it  in  a 
c>'lindrical  glass  jar,  such  as  a  preserve-jar,  screw  its  lid 
on  tightly,  place  on  ice,  and  allow  it  to  stand  from  four 
to  six  hours.  At  the  end  of  this  time  remove  the  jar 
carefully  without  .shaking,   fill   the  syphon  with   boiled 

1  The  measure  may  be  obtained  from  Blair  &  Ogilby,  Nineteenth  and  Chest- 
nut Streets,  Philadelphia,  at  a  cost  of  30  cents. 


FEEDING    THE   BABY. 


145 


water  {iiot  by  sucking  the  water  into  it),  close  the  longer 
arm  with  the  finger,  insert  the  short  arm  gently  down  to 
the  bottom  of  the  jar,  remove  the  finger,  and  syphon  off" 
all  bnt  six  ounces  of  the  milk.  This  milk  which  is  left 
is  the  "  top-milk." 

Another  method  recommended  is  the  removal  by  a  spe- 
cial dipper  (Fig.  47),  made  for  the  purpose,  and  holding 
one  fluidounce.  ^    The  milk  is  allowed  to  stand  in  the  quart 


Fig.  47. — The  Chapin  dipper. 

jar  as  before.  The  top  layer  of  cream  is  then  skimmed 
off  with  a  spoon  and  put  into  the  dipper.  As  soon  as 
enough  is  taken  to  prevent  the  milk  spilling  over,  the 
dipper  is  pushed  slowly  down  until  the  cream — /.  ^.,  the 
top-milk — flows  in  and  fills  it.  Six  dipperfuls  give  six 
ounces  of  top-milk. 

Top-milk  varies  in  strength  with  the  amount  removed. 
The  larger  the  quantity  obtained  from  a  quart,  the  weaker 


^  The  Chapin  dipper  can  be  obtained  from  James  T.  Dougherty,  409  West 
Fifty-ninth  Street,  N.  Y.,  ,  at  a  cost  of  twenty  cents. 
10 


146  THE   CAKE    OF  THE   BABY. 

this  is  in  fat.  It  is  by  no  means  necessary  always  to 
obtain  six  ounces.  Four,  six,  ten,  or  more  ounces  may 
be  needed  to  suit  the  requirements  of  the  child.  Of 
course,  such  changes  alter  completely  the  strength  of  the 
milk  mixture. 

The  top-milk  is  really  a  cream,  and  we  may  use  it  in 
the  following  formula,  which  makes  a  mixture  of  about 
the  same  strength  as  that  of  the  formula  just  given  : 

Top-MiLK  Mixture. 

Top-milk 2  oz.  ; 

Lime-water  or  soda-solution >^  oz.  ; 

Milk-sugar i  measure  ; 

Water,  sufficient  to  make 8  oz. 

The  jar,  lid,  syphon  or  dipper,  and  bottles  should  be 
washed  or,  preferably,  boiled  daily  before  using.  A 
series  of  lines  may  be  filed  on  the  jar,  showing  the  level 
at  which  different  amounts  in  ounces  still  remain  in  it. 
This  is  a  convenience  in  syphoning. 

The  two  formulae  given  are  intended  for  the  mother's 
instruction  only  in  so  far  that  she  may  see  in  actual  quan- 
tities about  what  the  comparative  strength  of  human 
milk  is.  She  is  strongly  urged  on  no  account  to  u.se 
them  without  medical  advice.  Although  they  give  mixt- 
ures which  resemble  human  milk  almost  as  closely  as  we 
can  make  them,  yet  it  by  no  means  follows  that  food  so 
prepared  is  at  all  what  her  infant  needs.  It  is  well  un- 
derstood that  very  3'oung  infants  constantly  require  at 
first  a  milk  mixture  which  is  much  weaker  than  the  nat- 
ural human  milk  would  have  been.  Later  many  of  them 
need  a  formula  much  stronger  than  those  given.  In  other 
cases  various  peculiarities  of  the  child  make  certain 
special  milk  mixtures  necessary'.     Much  depends  on  the 


FEEDING    TJJE   BABY.  1 47 

general  health  and  the  rate  of  growth.  In  fact,  of  recent 
years  physicians  have  been  learning  more  and  more  the 
foil}'  of  tr)ing  to  feed  all  infants  by  one  prescribed  rule. 
They  are  endeavoring  now  to  calculate  accurately  the 
actual  percentage  of  fat,  proteids,  and  sugar  which  each 
individual  baby  needs.  To  do  this  is  certainly  beyond 
the  power  of  the  mother,  and  the  problem  of  the 
baby's  feeding  should  always  be  referred  to  the  baby's 
physician. 

Having  determined  the  proper  ingredients  for  the 
milk  mixture,  and  their  amounts,  the  next  thing  to 
do  is  to  put  them  together  in  the  proper  manner.  The 
subject  of  sterilization  is  an  important  one  in  this 
connection.  Mother's  milk  as  drawn  from  the  breast 
has  been  found  to  be  entirely  or  nearly  free  from  those 
microscopic  germs  of  decomposition  which  are  the 
cause  of  souring.  Cow's  milk  as  it  comes  from  the 
udder  should  be  equally  free,  but  through  lack  of  cleanli- 
ness in  milking,  or  even  by  exposure  to  the  air  during 
the  delay  which  must  necessarily  occur  before  it  reaches 
the  baby,  it  becomes  infected  with  quite  enough  of  the 
germs  to  produce  the  poisonous  changes  which  have 
killed  so  many  infants.  The  fact  that  milk  appears  per- 
fectly sweet  is  no  criterion,  for  if  the  germs  are  already 
in  it  the  harmful  changes  may  take  place  even  after  the 
baby  has  had  its  meal.  As  it  is  generally  impossible  to 
procure  cow's  milk  sufficiently  free  from  the  germs,  the 
only  method  is  to  sterilize  the  milk — that  is,  to  kill  the 
germs.  We  must  never  forget,  however,  that  the  poison- 
ous matter  causing  indigestion  and  diarrhoea,  which  germs 
may  have  produced  in  milk  before  it  is  swallow^ed,  still 
remains  unaltered  by  sterilizing.  The  germs  are  killed 
by  the  process,  and  the  milk  grows  no  worse,  but  also 
grows  no  better.     It  is  therefore  of  the  utmost  importance 


148  THE   CARE    OF  THE  BABY. 

to  get  clean  milk  at  the  outset,  just  as  free  from  germs  as 
possible.  From  dairies  near  some  of  the  large  cities  of 
the  United  States  milk  can  now  be  obtained  which  is 
under  medical  supervision,  and  is  remarkably  pure  and 
needs  no  sterilizing  of  any  sort.  In  other  cases  cows  are 
owned  by  the  parents  of  the  baby,  and  the  milk  can  be 
carefully  supervised  and  special  precautions  taken  against 
contamination  with  germs,  so  that  here,  too,  sterilization 
of  any  kind  may  not  be  needed.  As  one  cannot,  as  a 
rule,  get  milk  of  the  kinds  described,  and  cannot  be  cer- 
tain of  the  degree  of  contamination  of  the  milk  which 
one  does  get,  sterilization  of  some  kind  is  usually  re- 
quired. There  are  various  means  which  may  be  employed 
for  accomplishing  this  end,  all  of  them  depending  upon 
the  fact  that  a  temperature  equalling  that  of  boiling  water, 
or  even  less,  if  applied  sufficiently  long,  will  prevent  sour- 
ing, and  will  also  kill  any  germs  of  such  diseases  as  ty- 
phoid fever,  diphtheria,  and  the  like  which  may  chance 
to  be  present.  The  milk  mixture  may  be  boiled  in  a 
vessel  immediately  before  using,  or  it  may  be  placed  in 
bottles  and  those  surrounded  by  boiling  water,  or  steamed 
in  a  farina  kettle  for  three-quarters  of  an  hour.  The  objec- 
tions to  actually  boiling  the  milk  are  that  it  gives  it  an 
unpleasant  taste,  and  probably  affects  its  chemical  char- 
acter in  a  such  a  way  that  it  becomes  less  digestible  than 
before.  It  is  also  very  troublesome,  because  it  must  be 
done  at  each  feeding.  The  other  methods  are  crude  and 
not  very  satisfactory.  It  is  far  better,  therefore,  to  pro- 
cure at  once  a  special  apparatus  for  sterilizing,  since  its 
initial  cost  is  small  and  it  will  save  a  world  of  trouble 
in  the  end.  It  should  be  almost  as  much  of  a  necessity 
in  the  household  as  are  the  baby's  clothes. 

The  great  principle  of  all  sterilizing  is,  first,  the  early 
killing  of  germs  present  in  the  milk,   and,  second,  the 


FEEDING    THE  BABY.  I49 

preventing  of  other  germs  from  entering  into  it  later.  If 
both  these  ends  are  fully  met,  the  milk  will  keep  sweet 
for  months  or  even  years.  Such  perfect  preparation  is, 
however,  seldom  attained,  and  is  not  necessary. 

There  are  two  classes  of  apparatus  used  to  accomplish 
the  destruction  of  the  germs:  one,  known  as  a  sterilizer, 
which  sterilizes  the  milk  at  a  boiling  temperature  (212° 
F.);  the  other,  called  a  Pasteurizer,  which  is  really  a 
modified  sterilizer,  killing  the  germs  at  a  much  lower 
temperature.  Of  recent  years  the  latter  has  become 
much  the  more  popular.  Of  the  sterilizer,  various  forms 
have  been  devised,  but  one  of  the  best  is  that  known  as 
Arnold's.  This  apparatus  is  provided  with  eight  bottles, 
each  holding  a  little  over  seven  ounces,  and  being  marked 
on  the  glass  with  a  graduated  scale  of  ounces,  by  means 
of  which  the  amount  of  nourishment  poured  into  them 
can  readily  be  measured  (Fig.  48).^ 

The  method  in  detail  for  preparing  the  baby's  food, 
including  the  use  of  the  sterilizer,,  is  as  follows  :  As  soon 
as  the  milk  and  cream  come  in  the  morning,  the  mixture 
for  the  entire  day  should  be  prepared  according  to  the 
formula  prescribed  by  the  baby's  physician.  As  large  a 
quantity  should  be  made  as  the  table  on  page  134  or  the 
experience  with  the  individual  child  shows  will  be  re- 
quired for  the  twenty-four  hours.  The  sugar  should  be 
dissolved  in  the  water,  and  the  other  ingredients  then 
added.  The  bottles,  previously  thoroughly  cleaned — by 
hands  which  are  themselves  thoroughly  clean — should 
each  be  filled  with  as  much  of  the  mixture  as  is  re- 
quired for  each  feeding.  They  must  next  have  their 
mouths  carefully  dried  and  stopped  with  plugs 
of     raw     cotton     (not      absorbent).      They     are      then 

1  Made  by  Wilmot  Castle  &  Co.,  Rochester,  N.  Y.,  and  sold  for  from  $3.00 
to  ^4.00,  according  to  size. 


150 


THE   CARE   OF  THE  BABY. 


placed  in  the  rack  in  the  sterilizing  chamber  and  the  lid 
and  hood  are  applied.  The  pan  of  the  sterilizer  is  now 
filled  two-thirds  full  with  water,  and  the  whole  is  placed 


Fig.  4S. — Aniuld  .-Urilii;er. 


on  the  hot  stove  for  an  hour.  About  twenty  minutes  of 
this  time  will  be  occupied  in  heating  the  milk  up  to  the 
high  temperature  required,  and  the  remainder  in  keeping 


FEEDING    THE   BABY.  I5I 

it  at  that  point  and  thus  sterilizing  it.  Raw  cotton  is 
used  as  a  plug  because  experience  shows  that  the  minute 
germs  cannot  pass  through  it.  It  is  best,  however,  that 
it  shall  not  come  into  contact  with  the  milk. 

When  it  is  desired  to  carry  the  bottles  about  to  any 
extent  after  sterilizing,  it  is  better  to  use  a  rubber  cork 
instead  of  the  cotton.  In  this  case  the  bottles,  with  the 
corks  very  loosely  in  place,  are  put  in  the  sterilizer  for 
about  twenty  minutes  until  the  liquid  and  the  air  con- 
tained is  thoroughly  heated.  The  corks  are  then  pushed 
firmly  into  place  and  the  sterilizing  is  continued.  The 
bottles  thus  corked  may  lie  afterward  in  any  position. 

Sterilized  milk  prepared  in  this  way  should  keep  per- 
fectly sweet  for  a  time  without  being  placed  on  ice.  As 
an  additional  safeguard,  however,  it  is  better  to  keep  the 
bottles  on  ice.  We  should  never  forget  that  the  cotton 
plug  must  not  be  removed,  even  for  a  moment,  from  the 
time  it  is  first  put  in  place  until  the  time  for  feeding  the 
baby  comes. 

When  milk  is  to  be  prepared  for  use  while  travel- 
ling, a  more  thorough  sterilization  is  necessary  in 
order  to  avoid  the  possibility  of  any  germs  being  left 
alive.  To  accomplish  this  the  bottles  of  milk  should  be 
subjected  to  sterilization  upon  one  day,  again  upon  the 
second,  and  then  again  upon  the  third. 

The  disadvantage  of  using  lime-water  in  preparing  the 
milk  mixture  becomes  evident  in  sterilizing.  It  is  largely 
precipitated  by  boiling,  and  is  thus  destroyed,  and  the 
alkalinity  of  the  mixture  is  reduced.  We  can,  of  course, 
obviate  this  by  adding  the  lime-water  to  each  bottle  just 
before  feeding  the  baby,  but  it  becomes  rather  a  compli- 
cated matter  to  calculate  just  what  quantity  of  it  is  re- 
quired with  the  gradually  increasing  amounts  of  nourish- 
ment which  the  babv  demands.    The  use  of  soda-solution 


152 


THE    CARE    OF   THE   BABY. 


Fig.  49. — Freeman's  Pasteurizer. 


instead  of  lime-water  allows  us  to  complete  the  mixture 
at  the  outset,  and  is  to  be  preferred  where  sterilization  is 
ordered. 

As  already  stated,  it  seems  probable  that  the  boiling  of 
milk,  or  even  the  sterilizing  of  it  in  the  manner  de- 
scribed, lessens  its  digestibil- 
ity to  a  considerable  extent. 
On  this  account  Pasteuriza- 
tion is  much  to  be  preferred, 
and  is,  indeed,  the  method 
now  approved  by  m.ost  physi- 
cians. The  process,  as  we 
have  seen,  is  only  a  modified 
sterilizing.  It  was  devised 
by  the  celebrated  French 
chemist  Pasteur,  and  first 
employed  in  the  manufacture  of  wine.  As  applied  to 
milk  it  consists  in  heating  the  bottles  containing  the 
milk  mixture  to  a  temperature  of  155°  or  167°  F.  instead 
of  to  212°,  as  in  ordinary  sterilizing,  and  in  then  remov- 
ing them  to  the  refrigerator  just  as  soon  as  they  will 
stand  the  cold.  It  has  been  found  that  this  process 
destroys  the  germs  sufficiently  for  practical  purposes,  and 
that  it  does  not  alter  the  digestibility  of  the  milk  or  affect 
its  taste. 

Of  the  devices  for  Pasteurizing,  a  very  satisfactory  and 
simple  one  is  the  Freeman  pasteurizer  (Fig.  49).  This 
consists  of  a  metal  pail  into  which  fits  a  rack  holding 
the  bottles,  much  as  in  the  sterilizer.  The  rack  has  a 
receptacle  for  each  bottle,  holding  just  enough  cold  water 
to  surround  the  bottle  and  keep  it  from  cracking  through 
a  sudden  change  of  temperature.  The  pail  is  partly 
filled  with  water,  heated  to  boiling  on  the  stove,  and  then 
removed.     The  rack  with  bottles,  prepared  as  for  steriliz- 


FEEDING    THE  BABY.  1 53 

ing,  is  then  placed  in  it,  the  lid  applied,  and  the  whole 
allowed  to  stand  on  a  table  for  forty-five  minutes.  The 
exact  quantity  of  water  required  has  been  accurately 
calculated  by  the  inventor.  The  scientific  principle 
involved  is  that  while  this  amount  of  water  cools,  the 
milk  in  the  bottles  grows  warm,  until  both  soon  reach 
the  desired  temperature.  After  the  forty-five  minutes 
have  elapsed  water  from  a  spigot  is  turned  into  the  pail 
in  order  to  cool  the  bottles  rapidly,  and  these  are  then 
kept  directly  upon  ice.  This  keeping  on  ice  is  important, 
as  pasteurized  milk  requires  rather  more  care  to  preserve 
it  than  sterilized  milk  does.  The  use  of  the  apparatus 
is  very  simple,  its  cost  is  small,  and  one  should  certainly 
be  procured  whenever  a  child  has  to  be  fed  artificially.^ 

It  is  perfectly  possible  to  Pasteurize  in  other  ways,  but 
the  process  is  troublesome,  for  to  obtain  satisfactory  re- 
sults the  temperature  must  be  exact.  We  may,  for  in- 
stance, use  the  Arnold  sterilizer,  leaving  the  hood  off  and 
setting  the  lid  ajar,  and  continuing  the  heating  for  forty- 
five  minutes.  But  to  be  sure  that  we  are  obtaining  the 
correct  temperature  it  is  necessary  to  have  a  special  ther- 
mometer in  one  of  the  bottles  and  to  watch  this  con- 
stantly. So,  too,  it  has  been  proposed  to  place  the 
bottles  of  milk  in  a  dishpan  or  large  saucepan  of  water, 
preferably  with  an  inverted  tin  pieplate  with  holes 
punched  in  it  laid  inside  as  a  false  bottom,  and  to  heat 
this  until  the  thermometer  in  the  water  reaches  170°  F. 
The  pan  should  then  be  removed  from  the  stove,  covered 
with  an  old  blanket,  and  allowed  to  stand  forty-five 
minutes.  But  here,  too,  the  troublesome  use  of  a  ther- 
mometer is  required,  and  after  the  pan  is  removed  from 

*  The  Freeman  pasteurizer  can  l>e  olitained  from  instrument-maker!^  or  drug- 
gists, or  from  the  manufacturer,  James  T.  Douglierty,  409  West  I'ifty-ninth 
Street,  New  York,  at  a  cost  of  t^-io. 


154  THE   CARE   OF  THE  BABY. 

the  stove  we  do  not  know  at  all  what  temperature  the 
milk  actually  maintaius.  The  results  cannot  be  accu- 
rate. 

Indeed,  Pasteurization,  though  so  simple  and  secure 
with  a  Pasteurizer,  is  not  a  safe  and  easy  process  with  any 
makeshift,  and  all  such  should  be  avoided.  It  is  much 
better  to  sterilize  outright  than  to  do  imperfect  Pasteur- 
ization. Far  better  than  either,  as  already  pointed  out, 
is  to  get  milk  which  needs  no  application  of  heat  to  pre- 
serve it.     Heat  for  this  purpose  is  only  a  choice  of  evils. 

A  few  words  must  be  said  about  the  articles  required 
for  feeding  the  baby  with  the  artificially  prepared  food, 
and  the  method  of  doing  this.  It  is  usually  unnecessary 
to  have  any  special  nursing-bottle,  for  the  ordinary  bottle 
used  in  the  Pasteurizer  answers  for  nursing  as  well. 
When  the  time  for  giving  nourishment  comes  this  bottle 
containing  the  prepared  milk  should  have  the  cotton 
plug  removed  and  be  fitted  with  a  rubber  nipple,  and 
then  be  set  in  a  cup  of  water,  which  should  be  heated 
until  the  contents  of  the  bottle  are  at  a  temperature  not 
exceeding  95°  to  100°. 

Since  the  baby  is  apt  to  wake  hungry  and  impatient 
in  the  night,  it  is  well  to  be  able  to  heat  its  milk  quickly. 
A  small,  narrow,  cylindrical  tin  vessel,  tall  enough  to  hold 
the  bottle  and  to  cover  it  with  water  to  the  neck  only, 
about  three  inches  in  diameter,  and  with  a  perforated 
false  bottom,  answers  the  purpose  admirably.  Such  a 
vessel,  heated  on  an  alcohol  pocket  stove,  or  preferably 
over  a  Bunsen  burner  or  other  gas  heating  apparatus, 
will  take  but  a  very  short  time  to  bring  the  milk  to  the 
proper  temperature,  whereas  a  receptacle  holding  a  large 
quantity  of  water  will  take  much  longer.  Any  tinsmith 
can  make  a  vessel  of  this  sort,  or  it  may  be  purchased 
from  the  agencies  of  the  Walker-Gordon  Milk  L^aboratory 


FEEDING    THE  BABY. 


155 


in  many  of  onr  cities  ^  (Fig.  50).     Many  mothers  endeavor 

to  lieat  the  baby's  food  by  putting  the  bottle  containing 

it  directly  into  hot  water.     This 

is  a  bad  plan,  as  it  is  liable  to  crack 

the  glass.     Heating  gradually  in 

the  way  described  takes  very  little 

longer. 

In  orivinor  the  bottle   the  child 

o  o 

should  be  laid  upon  the  back,  or 

should  be  held  in  the  arms  much 

as  in  the  position  for  nursing  from 

the  left  breast.    The  bottle  should 

be  held  in  the  hand,  and  its  position 

be  so  changed  from  time  to  time 

that  its  neck  is  always  full  of  milk. 

The   baby  requires   ten   or   more 

minutes  to  finish  its  meal.     If  the 

rubber  collapses,    or  if  the  milk 

does  not  flow  freely,  the  edge  of 

the  nipple  should  occasionally  be  lifted  from  the  neck  of 

the  bottle  for  a  moment  and  a  little  air  allowed  to  enter. 

It  is  well  in  any  case  to  withdraw  the  nipple  from  the 

child's  mouth  now  and  then  to  permit  of  a  moment's 

rest  or  to  allow  air  to  enter  the  bottle. 

When  the  child  has  emptied  its  bottle  it  must  be 
deprived  of  it  immediately.  If  the  bottle  has  not  been 
emptied  completely,  the  remaining  contents  must  be 
thrown  out  at  once.  To  let  the  baby  continue  to  suck 
after  the  bottle  is  empty  is  a  very  bad  practice.  If  the 
baby  is  allowed  to  suck  at  any  nipple  for  the  sake  of 
quieting  it  at  other  times  than  when  fed,  it  should  be  one 

'  The  cost  of  the  complete  apparatus  is  $2.00,  the  alcohol  lamp  being  $1.00, 
the  tin  food-warmer  50  cents,  and  the  thermometer  50  cents.  The  various 
parts  can  be  bought  separately. 


Fig.  50. 


Food-warmer  and 
lamp. 


156 


THE    CARE    OF  THE   BABY. 


of  the  lioleless  ones,  attached  to  an  ivory  disk — a  "  Com- 
forter," as  it  is  called  ;  but  the  advisability  of  permitting 
this  is  very  questionable.  It  is  very  apt  to  be  dirty,  and 
even  infected  from  frequent  falling  on  the  floor,  and  the 
constant  sucking  stimulates  the  salivary  glands  too 
greatly. 

Bottles  employed  for  feeding  should  be  made  very 
smooth  inside,  without  angles  and  depressions  which  col- 
lect milk  and  render  cleaning  difhcult.  Immediately 
after  nursing  the  bottles  should  be  rinsed  well  and  then 
submerged  in  a  strong  solution  of  washing-soda  and 
water.  They  should  stand  in  this  until  evening,  when 
they  may  be  rinsed  thoroughly  in  pure  water,  and  have 
the  interior  scrubbed  with  a  bristle  brush.  They  should 
finally  be  boiled  just  before  filling  them. 

The  rubber  nipples,  of  which  there  should  be  at  least 
two,  are  preferably  of  conical  shape  (Fig.  51).  Those  of 
black  rubber  are  rather  better  than  those 
of  white,  on  account  of  their  greater  soft- 
ness. Those  nipples  should  be  chosen 
which  have  the  least  odor  and  taste  ;  as 
babies  sometimes  object  to  this.  The 
openings  in  the  end  should  be  large  enough 
to  allow  the  milk  to  pass  freely  when 
sucked,  but  should  not  permit  it  to  flow 
too  fast.  When  the  bottle  is  inverted,  the 
milk  should  drop  easily  from  it,  but  not 
run  in  a  stream.  If  the  holes  are  not  of  sufficient  size, 
they  may  be  enlai;ged  with  a  hot  needle.  As  the  nipple 
gets  older  it  collapses  too  easily  and  the  holes  become 
too  large,  and  a  new  nipple  must  be  used.  There  are 
nipples  made  with  rubber  ribs  upon  the  inside,  the  object 
being  to  add  to  the  stiffiiess  and  prevent  collapsing. 
Others  come  without  holes,  in  order  that  the  mother  may 


Fig.  51.— Rubber 
nipple. 


FEEDING    THE   BABY.  1 57 

make  them  herself  of  the  size  she  desires.  At  once  after 
nursing  the  nipples  should  be  scrubbed  thoroughly  with- 
out, and  then,  by  inverting,  within,  with  a  soft  bristle 
brush,  and  after  this  be  kept  submerged  in  a  solution  of 
boric  acid  (Appendix,  79).  Once  a  day  all  the  nipples 
should  be  sterilized  by  boiling.  Just  before  using  they 
should  be  dipped  for  a  moment  in  hot  water.  The  nipple 
connected  with  the  bottle  by  a  long  rubber  or  glass  tube 
should  not  be  used  under  any  circumstances.  It  is  utterly 
impossible  to  keep  such  a  tube  clean,  and  the  device  can- 
not be  sufficiently  condemned. 

When  there  is  unusual  trouble  experienced  with  the 
collapsing  of  the  nipples,  some  special  method  of  allow- 
ing the  air  ingress  to  the  bottle  is  necessary.  There  is  a 
ventilated  nipple  on  the  market  which  answers  the  pur- 
pose very  well.  In  it  a  very  small  rubber  tube  connected 
with  the  outside  passes  from  the  side  of  the  nipple  into 
the  bottle.  This  nipple  is  more  difficult  to  keep  clean 
than  the  ordinary  form,  and,  unless  unusual  precautions 
are  taken,  some  form  of  ventilated  bottle  is  preferable. 
One  of  these  bottles  has  a  small  hole,  the  size  of  a  pin, 
perforated  through  its  neck  close  to  the  nipple.  A  nar- 
row elastic  band,  or  the  edge  of  the  nipple  itself,  covers 
this,  and  may  be  lifted  off  to  admit  air  when  necessary. 
Another  form  of  ventilated  bottle  has  an  air-valve  in  the 
bottom.  As  a  rule,  however,  no  special  method  of  allow- 
ing air  to  enter  is  needed  if  the  instructions  already  given 
are  followed.  In  case  special  nursing-bottles  of  any  kind 
are  desired,  there  should  be  at  least  two  of  them,  in  order 
that  one  may  have  ample  time  to  soak. 

(3)  The  Individual  Peculiarities  of  the  Child. — We 
have  to  consider  finally  the  third  factor  in  infant  feeding 
— namely,  the  element  of  idiosyncrasy,  which  renders 
the  nourishment  of  babies  not  the  simple  matter  it  might 


158  THE   CARE    OF   THE  BABY. 

otherwise  be.  With  all  our  care  the  cow's-milk  prepara- 
tion cannot  be  made  exactly  identical  with  woman's  milk. 
We  may  arrange  to  have,  for  instance,  exactly  the  same 
amount  of  proteids  in  each,  but  these  proteids  in  them- 
selves differ  somewhat  in  chemical  character.  Conse- 
quently, the  milk  mixture  prepared  theoretically  in  the 
best  manner  possible  may  not  agree.  The  physician  will 
then  try  to  discover  by  careful  study  of  the  symptoms 
what  combination  suits  the  baby  best.  It  is  here  that 
the  individuality  of  the  child  comes  in,  for,  of  course, 
what  answers  for  one  may  not  do  at  all  for  another.  In 
such  cases  we  may  try  certain  of  the  proprietary  infant's 
foods  on  the  market,  or  we  may  make  special  mixtures, 
increasing  or  oftener  decreasing  the  quantity  of  some  one 
or  more  of  the  ingredients  of  the  cow's  milk  mixture  ; 
or  we  may  predigest  the  food  or  modify  it  in  some  other 
way  until  we  discover  something  which  suits  the  baby's 
digestion.  I  cannot  too  strongly  urge  that  no  mother 
make  these  trials  on  her  own  responsibility.  The  problem 
is  too  serious  for  any  unskilful  experiments,  and  the  solu- 
tion often  exceedingly  difficult  even  for  the  most  expe- 
rienced physician. 

Regarding  the  numerous  patented  foods  it  need  only 
be  said  that  some  of  them  are  harmful  and  none  of  them 
are  necessary  or  desirable  for  a  child  with  a  healthy  diges- 
tion. All  are  made  from  cow's  milk,  just  as  the  mixture 
recommended  is.  Although  many  of  them  claim  to  be  "a 
perfect  substitute  for  mother's  milk,"  none  of  them  are 
this,  and  many  contain  starch  in  considerable  quantities. 
Others,  although  utilizing  starch,  have  transformed  it 
into  dextrin  or  malt-sugar  in  the  process  of  manufacture. 
This  procedure  certainly  presents  no  advantage  over, 
and  is  in  most  respects  inferior  to,  the  direct  addition  of 
milk-sug:ar  to  the  milk  in  the  manner   recommended. 


FEEDING    THE  BABY.  1 59 

Apart  from  the  fact  that  the  patent  foods  are  very  prone 
to  produce  rickets  or  scurvy,  the  very  best  of  them  are 
only  tolerably  successful  efforts  to  simulate  mother's 
milk,  and  this  is  no  more  than  we  can  do  ourselves  by 
following  formulae  given  by  a  physician.  A  mother  who 
wishes  to  feel  sure  that  her  baby  is  getting  nourishment 
upon  the  composition  of  which  she  can  fairly  well  depend 
will  prepare  her  own  mixture. 

In  the  rare  instances  in  which  some  individual  pecu- 
liarity exists  which  renders  it  advisable  that  an  infant  be 
tried  with  one  of  the  foods  upon  the  market,  the  physician 
in  charge,  and  not  the  mother  or  the  nurse,  should  have 
the  selection.  He  will  probably  choose  one  which  is  free 
from  starch.  The  mother  can  very  readily  and  simply, 
in  the  following  way,  satisfy  a  laudable  curiosity  regard- 
ing the  presence  of  starch  in  any  of  the  foods  on  the 
market:  Dissolve  a  portion  in  hot  water,  add  a  few  drops 
of  tincture  of  iodine  to  a  tablespoon ful  of  water,  mix  a 
little  of  this  with  the  dissolved  food,  and  if  starch  is 
present  a  blue  color  will  result. 

There  is  one  form  of  prepared  food  on  the  market 
which  is  scarcely  ever  admissible — namely,  condensed 
milk.  When  it  is  diluted  sufficiently  to  make  the  pro- 
teids  digestible  it  contains  far  too  little  fat  ;  and  in  many 
cases  it  is  diluted  so  much  that  the  proportion  of  pro- 
teids  also  is  much  less  than  it  should  be.  I  have  seen  so 
many  babies  starving  on  condensed  milk  that  I  now 
rarely  give  it.  It  is  true  that  some  babies  grow  fat  and 
are  seemingly  healthy,  but  the  health  is  often  only  ap- 
parent, and  rickets  is  very  liable  to  result.  If  food  is 
necessary  during  the  first  few  days  of  life,  before  the 
secretion  of  the  breast  is  established,  condensed  milk  may 
be  employed;  but  even  then  it  offers  no  special  advantage 
over  feeding  with  a  much  diluted  cow's  milk  mixture. 


l6o  THE    CARE    OF   THE  BABY. 

The  only  other  time  when  condensed  milk  may  be  advan- 
tageously used  is  upon  railway  journeys  and  the  like,  but 
even  then  it  is  better  to  use  milk  which  has  been  spe- 
cially sterilized,  as  recommended  upon  page  151.  Con- 
densed milk  could,  of  course,  be  strengthened  by  the 
addition  of  cream  before  using,  and  thus  made  a  service- 
able food,  but  this  method  presents  no  advantage  over 
that  of  preparing  the  food  entirely  at  home  in  the  manner 
already  described. 

In  place  of  the  commercial  foods  there  are  several 
home-mixed  milk  preparations  which  experience  has 
shown  to  be  of  value  in  some  cases  of  delicate  digestion. 
One  of  these  is  the  gelatin  food  which  was  recommended 
by  Dr.  J.  F.  Meigs  (Appendix,  14).  The  gelatin  and  the 
arrowroot  in  this  mixture  seem  to  prevent  the  formation 
of  so  heavy  a  curd.  Another  useful  preparation  in  some 
cases  is  one  into  which  whey  and  cream  enter  in  varying 
proportions  (Appendix,  17).  Another  serviceable  for- 
mula in  cases  of  delicate  digestion  is  a  mixture  of  whey 
and  ^<g<g  (Appendix,  15).  Still  another  is  a  mixture  of  i 
part  of  cream  and  5  or  6  parts  of  water  or  barley-water. 
These  cream  mixtures  are  often  of  great  service  where  a 
child  cannot  take  milk  at  all.  There  are  still  other 
preparations,  such  as  albumen- water  (Appendix,  3),  veal 
tea  (Appendix,  19),  etc.,  which  contain  neither  milk  nor 
cream.  Their  use,  however,  is  limited  entirely  to  children 
who  are  actually  ill  rather  than  to  those  with  delicate  di- 
gestion merely  or  with  some  idiosyncrasy  regarding  food. 

In  some  instances  peptonizing  the  food  is  of  great 
service.  The  method  of  doing  this  will  be  described 
later  (Appendix,  27-38).  We  must  bear  in  mind  that  the 
administration  of  a  predigested  food  during  a  long  period 
takes  away,  to  some  extent,  the  power  of  the  stomach  to 
do  its  own  digestion. 


FEEDING    THE   BABY.  l6l 

The  admixture  of  thickening  substances  containino- 
starch  for  the  purpose  of  ''breaking  the  curd"  is  not  to 
be  recommended  as  a  routine  practice.  In  some  in- 
stances, however,  it  is  certainly  of  benefit.  (See  Oat- 
meal-water, Arrowroot-water,  and  Flour-ball;  Appendix 
5,  7,  20). 

In  this  connection  we  may  consider  more  at  length  the 
very  important  subject  already  referred  to— that  ""of  the 
administration  of  food  containing  starch.     An  infant  in 
the  first  few  months  of  life  possesses  only  slight  power 
of  digesting  starch.     The  pancreatic  juice  and  the  saliva, 
the  function  of  which  it  is  to  digest  starch,  are  little  devel- 
oped at  this  period,  and  even  after  the  age  of  four  months 
the  power  increases  but  slowly.     It  is  a  very  frequent  cus- 
tom with  mothers  to  give  children  a  crust  of  bread  to  bite 
upon.     Indeed,  a  baby  is  lucky  if  it  gets  off  without  any 
further   maternal   experimentation    than   this,   for   it   is 
during  the  first  eighteen  months  of  life  that  so  many 
innocents  are  slaughtered  by  "just  a  taste  "  of  table  food, 
given  on  the  ground  that  because  they  wanted  it,  it  was 
right  for  them  to  have  it.     It  is  best  not  to  allow  even  a 
crust  before   the    child   is  nine  or  ten  months  old,   by 
which  time  a  thriving  baby  may  take  starch  in  small 
quantities  without  disadvantage  in  the  winter,  although 
it  does  not  need  it.     The  better  course,  however,  is  "to 
allow  no  starch,  nor,   in  fact,  anything  but  milk,   until 
the  age  of  one  year.     In  very  hot  weather  no  change 
whatever  should  be  made  in  the  diet,  even  though  the 
child  be  more  than  a  year  old. 

Of  course,  these  remarks  apply  only  to  thriving  chil- 
dren. It  sometimes  happens  in  the  last  months  of  the 
first  year,  or  even  earlier,  that  the  diet  must  be  supple- 
mented in  various  ways,  as  by  certain  meat  foods,  such 
as  the  yellow  of  ^%^,  beef-juice  and  various  peptonized- 
11 


1 62  THE    CARE    OF   THE  BABY. 

beef  preparations,  and  sometimes  even  b}'  starch  in  con- 
siderable quantity;  but  a  healthy  baby  does  not  need 
these  things,  and  should  not  receive  them  except  by 
medical  advice.  So,  too,  it  is  often  necessary  during  the 
latter  part  of  the  first  year,  if  the  baby  is  not  growing  at 
the  proper  rate,  to  increase  the  amount  of  milk  in  the 
mixture  to,  perhaps,  one-quarter,  one-half,  or  even  a 
larger  fraction  of  the  total  volume ;  but  this  should  not 
be  done  unless  it  is  actually  and  undoubtedly  required 
(see  p.  135). 

We  have  so  far  considered  only  the  manner  of  feeding 
a  baby  before  the  time  of  weaning.  After  it  has  been 
fully  weaned  its  nourishment  may  be  gradually  increased 
in  strength.  This  applies  equally  well  to  a  bottle-fed  baby 
who  has  reached  the  usual  age  for  weaning.  By  about 
the  age  of  twelve  months  a  child  may  be  fed  upon  but 
little  diluted  milk  and  may  begin  to  take  other  articles 
of  diet  in  addition,  such  as  beef-juice,  eggs,  and  starchy 
food  in  moderate  quantity.  These  will  be  given  from  a 
spoon,  but  the  milk  may  be  given  from  a  bottle  as  long 
as  the  child  is  inclined  to  take  it  in  this  way.  Some- 
where between  sixteen  and  eighteen  months  of  age  most 
children  should  learn  to  take  most  of  their  milk  from  a 
cup.  Taking  it  from  a  bottle  before  they  sleep  in  the 
morning  and  at  night  is,  however,  a  great  comfort  to 
them  even  after  this  period. 

As  a  guide  for  the  feeding  of  a  child  of  from  twelve  to 
eighteen  months  the  following  diet  list  may  be  of  service. 
The  numbered  menus  indicate  the  choice  that  the  mother 
may  have,  alternating  them  so  that  the  child  will  not  tire 
of  any: 


FEEDING    THE   BABY.  '         1 63 

i)iET  FROM  One  Year  to  Eighteen  Months. 

Breakfast  (6  to  7  A.  m.). — (i)  A  glass  of  milk  with  stale  bread 
broken  in  it.  (2)  Oatmeal,  arrowroot,  wheaten  grits,  hom- 
iny grits,  etc.,  or  one  of  the  numerous  good  breakfast- 
foods  on  the  market,  made  into  a  porridge  and  well  cooked, 
and  with  the  milk  mixture  in  use  poured  over  it.  (3)  A 
soft-boiled  or  poached  0.^%  with  bread  broken  in  it,  and  a 
glass  of  milk. 

Second  Meal  (10  a.  m.). — A  glass  of  milk. 

Dinner  (1.30  to  2  p.  m.) — (i)  Bread  moistened  with  dish-gravy 
(no  fat),  beef-tea,  or  beef-juice  (Appendix,  24) ;  a  glass  of 
milk.  (2)  Rice  or  grits  moistened  in  the  same  way  ;  a 
glass  of  milk.  {3)  A  soft-boiled  ffg^  and  stale  bread 
thinly  buttered ;  a  glass  of  milk. 
Rice,  sago,  or  tapioca  pudding,  or  junket,  in  small  quantities 
as  dessert  with  any  of  these  diets. 

Fourth  Meal  (5  p.  m.). — A  glass  of  milk  or  some  bread  and 
milk. 

Fifth  Meal  (9  to  10  p.  m.). — A  glass  of  milk. 

It  is,  of  course,  understood  that  the  baby  does  not  sud- 
denly plunge  into  any  such  diet  at  twelve  months,  but 
that  the  list  and  the  variety  are  only  very  gradually  in- 
creased, and  that  milk  remains  the  principal  article  of 
diet.  Porridge  of  some  sort  is  the  first  new  article  of 
diet  tried,  one  not  of  oatmeal  being  first  u.sed,  as  this  is 
rather  more  difficult  of  digestion  than  most  of  the  other 
cereals.  Eggs  are  given  a  little  later,  as  they  are  very 
liable  to  disagree  with  some  children.  The  bread  used 
is  more  nutritious  if  made  of  whole  wheat  flour  rather 
than  of  white  flour.  The  last  meal  should  be  given  only 
if  the  child  wakens.  If  it  rouses  some  hours  before  the 
time  for  the  first  morning  meal,  and  remains  awake,  it 
should  be  given  a  cup  of  milk  to  stay  the  stomach  until 
breakfast.  It  is  no  longer  necessary  at  this  age  to  pas- 
teurize the  milk  in  cool  weather,  if  care  is  taken  to  keep 
it  carefully.    In  hot  weather  it  is  safer  to  pasteurize  it  still. 


164  THE    CARE    OF   THE  BABY. 

After  the  age  of  eighteen  months  up  to  that  of  two 
years  the  diet  is  only  very  little  more  extended.  The 
following  list  will  be  a  guide: 

Diet  from  Eighteen  Months  to  Two  Years. 

Breakfast  (7  a.  m.). — (i)  A  glass  of  milk  with  a  slice  of  bread  and 
butter  or  a  soda,  Graham,  oatmeal,  or  similar  unsweetened 
biscuit.  (2)  A  soft-boiled  ^^%  with  bread  and  butter  and  a 
glass  of  milk.   (3)  Porridge  as  described  in  the  previous  list. 

Second  Meal  (10  A.  m.). — (i)  Bread  broken  in  milk.  (2)  Bread 
and  butter  or  a  soda  or  other  biscuit  with  a  glass  of  milk. 

Dinner  (2  p.m.). — (i)  Boiled  rice  or  a  baked  potato  mashed  and 
moistened  with  dish-gravy  or  beef-juice;  a  glass  of  milk. 
(2)  Mutton  or  chicken  broth  with  barley  or  rice  in  it ; 
some  bread  and  butter,  and  some  sago  or  rice  pudding 
made  with  milk.  (3)  A  small  portion  of  minced  white  meat 
of  chicken,  or  turkey,  or  minced  rare  roast-beef,  beefsteak, 
lamb,  mutton,  or  fish  ;  bread  and  butter  ;  a  glass  of  milk. 

Fourtb  Meal  (5  p.  m.). — (i)  Bread  and  milk.  (2)  Bread  and 
butter  and  a  glass  of  milk. 

It  is  probable  that  no  fifth  meal  will  be  needed,  but  if 
it  is,  it  shoiild  consist  only  of  milk.  It  is  important  to 
know  that  not  every  child  can  digest  potato  easily,  and 
that  this  variety  of  starchy  food  must  be  tried  with 
caution.  Further,  that  many  children  have  great  diffi- 
culty in  digesting  any  form  of  starch.  In  such  cases  the 
diet  should  be  chiefiy  of  animal  food  during  the  first  two 
years  of  life.  It  is  also  true,  however,  that  some  children 
cannot  take  meat  daily  without  evidences  of  its  affecting 
the  health  unfavorably  in  some  way.  In  my  experience 
the  diet  list  given  suits  the  average  healthy  child,  and 
when  exceptions  to  this  are  found  medical  advice  should 
be  obtained. 

After  the  child  has  cut  sixteen  or  twenty  teeth — say, 
by  the  age  of  two  years — we  may  still  further  increase 
the  diet  by  allowing  it  to  eat  solid  meat  food.    For  dinner 


FEEDING    THE   BABY.  1 65 

it  may  have  tender  chicken,  fish,  mutton,  or  beef  cut 
small  but  without  actual  mincing.  Fresh  or  stewed 
fruits  in  small  quantity  are  also  good,  among  these  being 
included  raspberries,  strawberries,  grapes  freed  from  the 
seeds,  peaches,  juice  of  oranges,  and  stewed  apples. 
Bananas  should  not  be  given.  Indeed  the  use  of  orange 
juice  or  of  some  cooked  fruit  is  often  advantageous  before 
this  age,  especially  if  there  is  any  tendency  to  constipa- 
tion (see  p.  271). 

The  diet  from  two  to  three  years  may  be  as  follows  : 

Diet  from  Two  to  Three  Years. 

Breakfast  (7  to  8  A.  m.). — (i)  A  small  portion  of  beef-steak, 
with,  oatmeal,  hominy  grits,  wheaten  grits,  corn  meal,  or 
other  cereal  porridge  with  plenty  of  milk.  (2)  A  soft- 
boiled  ^%^,  bread  and  butter,  and  a  glass  of  milk. 

Second  Meal  (11  a.  m.). — (i)  A  glass  of  milk  with  bread  and 
butter  or  with  a  soda  or  other  biscuit.  (2)  Bread  and 
milk.     (3)  Chicken  or  mutton  broth. 

Dinner  (2  p.m.). — Roasted  fowl,  mutton,  or  beef  cut  fine; 
mashed  baked  potato  with  butter  or  dish-gravy  on  it ; 
bread  and  butter.  As  dessert,  tapioca,  sago,  or  rice  pud- 
ding, junket,  or  some  of  the  fruits  mentioned. 

Supper  (6  p.  m.). — (i)  Bread  and  butter.  (2)  Milk  with  soda  or 
similar  biscuit  or  with  bread  and  butter. 

It  is  very  necessary  to  bear  in  mind  two  facts  regard- 
ing these  tables:  first,  that  they  are  only  a  guide,  not 
an  absolute  rule,  both  as  to  the  time  of  meals  and  as  to 
the  nature  of  the  food;  and,  second,  that  they  rather 
represent  the  extreme  of  what  a  child  can  take  than  in- 
dicate what  every  child  ought  to  have.  Although 
mothers  are  very  prone  to  worry  because  their  children 
are  not  getting  "strong  enough  food,"  there  is  less  dan- 
ger of  this  happening  than  of  the  food  being  too  strong. 
Many  a  baby  does  wonderfully  well  almost  with  milk 


1 66  THE    CARE    OF  THE   BABY. 

alone  long  after  others  are  taking  a  diet  somewhat  like 
the  list  given  for  the  age  of  eighteen  months  to  two 
years.  In  such  a  case  it  is  folly  to  alter  the  diet  hastily. 
The  weight  and  the  general  condition  of  the  baby  are  far 
better  guides  than  the  number  of  months  old  which  it  hap- 
pens to  be  or  the  number  of  teeth  cut.  It  is  always  very 
important,  as  previously  pointed  out,  to  make  no  changes 
during  the  hot  weather  when  it  is  possible  to  avoid  doing 
so.  On  the  least  disturbance  of  the  digestion,  too,  the 
diet  should  be  cut  down  to  milk  for  a  day  or  two. 

From  the  age  of  about  two  and  a  half  years  onward  the 
child  may  sit  at  the  table  in  its  high  chair  with  the  fam- 
ily, or  at  a  small  table  close  to  the  mother  if  this  is  found 
desirable.  If  it  never  receives  articles  of  diet  not  suited 
to  it,  it  will  soon  learn  not  to  ask  for  them.  At  the  age 
of  three  years  the  child  may  have  its  diet  considerably 
increased  in  variety,  since  it  has  now  acquired  powers  of 
digestion  much  more  like  those  of  the  adult.  Some  of 
the  green  vegetables  are  of  advantage.  It  is  very  impor- 
tant at  this  age  to  prevent  a  child  from  helping  itself  to 
all  sorts  of  edible  articles  both  at  the  table  and,  especially, 
between  meals.  If  it  is  really  hungry,  there  is  no  objec- 
tion to  its  having  some  simple  thing  between  meals,  not 
sufficient  in  amount  to  lessen  the  appetite  at  the  regular 
meal-time.  It  is  impossible  to  give  any  series  of  distinct 
diet  lists  for  the  age  of  three  years  and  onward,  inasmuch 
as  the  child  now  eats  selections  from  the  food  provided 
for  the  family  in  general.  Care  must  be  taken  that  it 
receives  no  indigestible,  highly  seasoned,  or  made-over 
dishes,  and  that  it  masticates  slowly  and  thoroughly. 
The  chief  meal  (dinner)  ought  always  to  be  in  the  middle 
of  the  day,  and  the  supper  always  light,  as  of  bread  and 
milk  or  cereals  and  milk,  in  order  that  sleep  may  be 
sound.     Milk  should  still  constitute  a  very  large  part  of 


FEEDING    THE   BABY.  1 67 

the  diet,  and  meat  more  than  once  a  day  is  often  a  disad- 
vantage. Cocoa  is  serviceable  in  some  cases.  Cream 
may  be  poured  in  small  amounts  over  the  porridge  given. 
The  following  lists  may  serve  as  a  guide  to  the  kinds  of 
food  suitable  to  a  child  of  three  years  and  later,  and  to 
those  which  must  be  used  with  care  or  be  avoided.  Of 
course,  as  the  child  passes  this  age  the  list  of  permissible 
articles  gradually  increases  until,  by  the  time  of  puberty, 
or  earlier,  the  diet  is  practically  that  of  adults. 

Foods  Permitted. 

Meats. — Broiled  beef-steaK,  lamb  chops,  and  chicken  ;  broiled 
liver ;  roasted  or  boiled  beef,  mutton,  lamb,  chicken,  and 
turkey  ;  broiled  or  boiled  fish  ;  raw  or  stewed  oysters. 

Eggs. — Soft-boiled,  poached,  scrambled,  omelette. 

Cereals. — Light  and  not  too  fresh  wheaten  and  Graham  bread, 
toast,  zwieback  ;  plain  unsweetened  biscuit,  as  oatmeal, 
Graham,  soda,  water,  etc.  ;  hominy  grits,  wheaten  grits, 
corn  meal,  barley,  rice,  oatmeal,  maccaroni,  etc. 

Soups. — Plain  soup  and  broth  of  nearly  any  kind. 

Vegetables. — White  potatoes,  boiled  onions,  spinach,  peas, 
asparagus,  except  the  hard  parts,  string  and  other  beans, 
salsify,  lettuce,  stewed  celery,  young  beets,  arrowroot, 
tapioca,  sago,  etc. 

Fruits. — Nearly  all  if  stewed  and  sweetened  ;  of  raw  fruits, 
peaches  are  one  of  the  best  ;  pears  ;  well-ripened  and 
fresh  raspberries,  strawberries,  blackberries  ;  grapes  with- 
out the  skin  and  seeds  ;  oranges. 

Desserts. — Light  puddings,  as  rice  pudding  without  raisins, 
bread  pudding,  etc.,  plain  custards,  wine  jelly,  ice-cream, 
junket. 

Food  to  be  Taken  with  Considerable  Caution. 

Kidney,  mufi&ns,  hot  rolls,  sweet  potatoes,  baked  beans,  squash, 
turnips,  parsnips,  carrots,  egg-plant,  stewed  tomatoes,  green  corn, 
cherries,  plums,  apples,  huckleberries,  gooseberries,  currants. 


1 68  the  care  of  the  baby. 

Foods  to  be  Avoided. 

Fried  food  of  anj-  kind  ;  griddle-cakes  ;  pork  ;  sausage  ;  highly 
seasoned  food  ;  pastry  ;  all  heavy,  doughy,  or  very  sweet  pud- 
dings, unripe,  sour,  or  wilted  fruit ;  bananas,  pineapples,  cucum- 
bers, raw  celerj',  raw  tomatoes,  cabbage,  cauliflower,  nuts,  candies, 
preserved  fruits,  jams,  tea,  coffee,  alcoholic  beverages. 

The  feeding  of  a  child  when  sick  is  such  an  important 
matter,  and  one  so  very  difficult,  that  it  must  be  left  nearly 
entirely  to  the  judgment  of  the  physician.  The  remarks 
already  made  upon  the  feeding  of  children  with  delicate 
stomachs  or  with  idiosyncrasies  regarding  food  apply  in 
this  connection  also.  The  further  brief  consideration 
which  we  can  give  to  the  general  principles  tuiderlying 
the  subject  will  be  found  in  Chapter  XI.,  in  the  section 
upon  the  Management  of  Sick  Children. 

In  the  Appendix  will  be  found  some  recipes  for  various 
forms  of  food  useful  in  sickness  and  health,  including 
food-preparations  for  use  in  the  bottle. 


CHAPTER    VII 
SLEEP. 

A  VERY  young  baby  is  asleep  nearly  all  the  time  except 
when  nursing  or  having  its  toilet  made.  Its  total  amount 
of  sleep  should  be  about  eighteen  to  twenty  hours  every 
day.  As  it  grows  older  it  sleeps  less  and  less,  and  at  the 
age  of  two  months  it  will  often  lie  awake  quietly  for  an 
hour  or  so  at  a  time.  By  the  time  it  is  a  year  old  it 
requires  fifteen  or  sixteen  hours  of  sleep  ever}^  day;  at 
two  to  three  years,  twelve  or  thirteen  hours;  at  four  to 
five  years,  ten  or  eleven  hours;  and  at  twelve  to  thirteen 
years,  nine  or  ten  hours.  A  baby  who  is  sleepless  and 
fretful   at   night   generally   has    something   the    matter 


SLEEP.  169 

with  it  or  else  has  been  badly  trained.  It  is  important 
from  the  very  first  to  accustom  a  child  to  sleep  at  definite 
hours,  else  the  parents'  lives  are  in  danger  of  becoming 
a  burden  to  them.  To  walk  the  floor  night  after  night 
or  to  be  obliged  to  sit  up  with  a  healthy  child  and  sing 
it  to  sleep  is  a  form  of  martyrdom  which  is  entirely  un- 
called for.  Provided  one  is  sure  that  the  baby  is  not  sick, 
it  should  be  put  to  bed  and  not  be  taken  up  again  to 
induce  it  to  sleep,  and  the  mother  should  avoid  sitting  in 
the  room  unless  she  wishes  to  be  obliged  to  sit  there  every 
evening.  If  the  little  one  never  knows  any  other  way 
than  this  of  being  put  to  sleep,  there  will  usually  be  no 
difficulty  in  the  matter  after  it  has  once  learned  its  les- 
son; but  to  begin  the  training  and  not  persistently  to 
continue  it  is  a  fatal  yielding  of  which  the  child  will  be 
sure  to  take  advantage  when  a  second  battle  begins.  The 
training  cannot  be  begun  too  earlv.  It  is  astonishing  at 
how  early  an  age  a  baby  learns  that  it  has  only  to  cry  to 
get  what  it  wants. 

Except  for  the  first  few  days  of  life,  during  which,  as 
is  generally  thought  best,  it  should  lie  on  its  right  side 
as  much  as  possible,  the  position  which  a  healthy  child 
assumes  while  sleeping  is  a  matter  of  not  the  slightest 
consequence.  If  it  wants  to  lie  on  its  stomach,  there  is 
no  possible  good  objection  to  be  raised  against  it.  There 
is  sometimes  a  great  deal  of  needless  anxiety  among 
mothers  with  regard  to  this  matter.  It  is  only  in  a  rickety 
child  that  a  deformity  would  be  liable  to  occur  from  the 
habit — as  would  equally  well  result  from  the  constant  as- 
sumption of  any  other  position.  We  must  remember  the 
necessity  of  varying  and  changing  the  position  now  and 
then  of  every  child  too  young  or  too  feeble  to  turn  itself 
easily  and  often. 

Before  the  age  of  four  or  five  months  the  baby  is  put  to 


I/O  THE    CARE    OF   THE   BABY. 

bed  at  5.30  or  6  p.  M.,  and  should  rouse  but  once  or  twice 
during  the  night.  After  this  age  it  should  go  to  bed  at  6 
or  7  in  the  evening  after  nursing,  be  awakened  and  fed  at 
9  or  10  P,  M.,  but  be  trained  to  sleep  without  further 
nursing  until  6  or  7  in  the  morning.  It  will  then  need 
feeding  again,  after  which  it  may  again  sleep  if  it  desires. 
Through  the  day  it  may  at  first  sleep  as  much  as  it  feels 
inclined,  but  it  is  sometimes  a  good  plan,  by  the  time  it 
is  a  month  old,  to  encourage  its  keeping  awake  for  about 
an  hour  before  its  bed-time,  in  order  that  it  may  have  a 
better  night's  rest. 

By  the  time  the  baby  is  six  months  old  it  may  perhaps 
begin  to  limit  its  sleep  by  day  to  a  nap  in  the  morning 
of  from  one  and  a  half  to  two  hours.  As  a  rule  the  baby 
should  not  be  allowed  to  lengthen  its  morning  nap  too 
greatly,  or  the  hours  for  feeding  will  be  badly  interfered 
with.  If  it  is  taken  up  regularly  at  a  certain  time,  it 
will  soon  learn  to  rouse  then  of  its  own  accord.  The 
time  for  the  morning  nap  will  depend  largely  upon  the 
hours  of  nursing,  and  to  some  extent  also  upon  the  duties 
of  the  mother  if  she  has  the  sole  care  of  the  baby.  The 
child  should  be  undressed  for  it  and  be  regularly  put  to 
bed.  Often  at  this  age  a  short  afternoon  nap  is  needed, 
but  this  should  not  last  longer  than  until  4  p.  M.,  lest  the 
night's  rest  be  interfered  with,  and  it  should  not  be  allowed 
unless  the  child  does  not  do  well  without  it.  At  one  year 
of  age  and  on  to  the  age  of  two  years  the  same  arrange- 
ment of  the  sleeping  hours,  including  the  hour  for  going 
to  bed,  holds  good,  except  that  an  afternoon  nap  is  not 
desirable.  The  morning  sleep  will  then  be  of  two  hours' 
duration,  beginning  at  11  or  12.  If  the  fifth  meal  at  10 
p.  M.  is  not  required,  the  child  can  sleep  uninterruptedly 
throughout  the  whole  night.  At  two  years  of  age  the 
morning  sleep  is  shortened  to  one-half  or   one    hour. 


SLEEP.  171 

From  this  time  up  to  the  age  of  four  or  five  the  morning 
sleep  is  advisable  if  the  child  will  take  it,  but  is  not  to 
be  insisted  upon.  Children  of  four  years  or  older  should 
continue  to  go  to  bed  at  8  o'clock  or  earlier,  and  the  hour 
should  gradually  be  changed  to  9  o'clock  by  the  age  of 
ten  or  twelve  years. 

A  certain  degree  of  latitude  is  to  be  allowed  to  all  that 
has  been  said.  For  instance,  if  a  child  persistently 
wakens  very  early  in  the  morning  and  does  not  go  to 
sleep  again,  it  is  better  to  make  the  bedtime  somewhat 
later.  So,  too,  a  child  must  be  allowed  to  wake  of  its 
own  accord  in  the  morning,  even  though  the  regular 
hour  be  passed.  This  is  certainly  true  up  to  the  age  of 
four  or  five  years,  and  even  after  this  it  must  be  remem- 
bered that  children  need  a  great  deal  of  sleep.  If  rising 
at  a  certain  hour  in  the  morning  is  necessary,  and  the 
child  seems  tired,  the  hour  for  retiring  must  be  made  a 
little  earlier.  In  no  case  must  the  amount  of  sleep 
desired  be  curtailed.  A  child  of  any  age  should  not  be 
allowed  to  lie  in  bed  after  thoroughly  awake. 

It  is  important  to  preserve  great  regularity  in  the  hours 
of  sleeping.  Few  things  upset  a  child  more  than  a  failure  to 
do  this.  There  should  be  no  romping  games  or  excite- 
ment of  any  nature  for  at  least  an  hour  before  going  to 
bed  at  night,  or  the  child  will  be  apt  to  sleep  badly. 

We  must  next  determine  what  is  best  for  the  baby  to 
sleep  in.  It  should  never  sleep  in  the  bed  with  its 
mother.  Not  only  is  there  a  possible  danger  of  her  over- 
lying it — a  danger  which  is  real  and  not  imaginary, 
since  statistics  show  that  it  occurs  very  frequently,  and 
history  records  it  even  as  long  ago  as  the  time  of  King 
Solomon — but  there  is  a  constant  temptation  to  nurse  it 
too  often.  The  baby,  on  its  part,  acquires  the  bad  habit 
of  nursing  only  partially,  sleeping  a  short  time,  rousing, 


1/2  thj£  care  of  the  baby. 

and  nursing  again.  Moreover,  it  is  very  liable  to  get  the 
covers  over  its  head  and  to  obtain  much  less  fresh  air 
than  it  should. 

The  first  bed  generally  used  for  the  baby  is  the  bas- 
sinet, and  sleep  should  begin  in  this  from  the  first  day  of 
life.     The  bassinet  consists  of  a  wicker  basket  with  high 


Fig.  52. — Bassinet. 

sides  and  with  or  without  a  hood  over  one  end.  It 
should  stand  high,  so  as  to  avoid  draughts  on  the  floor. 
It  should  not  be  too  large  to  be  easily  portable,  in  order 
that  it  may  be  readily  moved  from  one  room  to  another 
if  desired.  It  may  conveniently  be  lined  with  some 
colored  or  white  material  and  covered  outside  with  Swiss 


SLEEP.  173 

muslin  ;  but  these  and  any  further  decorations  may  be 
as  varied  and  as  elaborate  as  the  mother  pleases.  It 
is,  however,  better  to  have  them  simple  and  inexpen- 
sive, to  permit  of  changing  them  when  dusty  or  soiled. 
The  illustration  shows  one  of  the  ordinary  forms  of  bas- 
sinet furnished  in  the  shops  (Fig.  52).  A  large  oval 
clothes-basket  would  answer  as  a  substitute. 

The  bassinet  is  superior  to  the  crib  for  the  early 
months  of  life,  because  it  gives  the  child  more  support  at 
the  sides  and  keeps  it  warmer  if  well  tucked  in.  Cur- 
tains may  be  fitted  to  it,  and  are  of  service  if  there  is 
any  danger  of  draughts,  but  as  they  cut  off  the  fresh  air 
and  catch  the  dust  it  is  better  to  do  without  them; 
place  the  bassinet  in  a  sheltered  situation,  and  protect 
it,  if  necessary,  from  draughts  and  light  by  a  portable 
screen. 

A  cradle  may  be  used  instead  of  the  bassinet.  The 
form  with  projecting  rockers  is  a  constant  invitation  to 
everybody  to  trip  over  them,  and  the  swinging  form  is 
also  not  to  be  recommended  unless  it  is  never  swung. 
Although  the  rocking  probably  does  no  harm,  it  is 
against  all  the  principles  of  training  which  we  have  been 
considering  to  make  it  a  necessity  in  putting  the  child  to 
sleep.  If  the  child  has  never  been  rocked,  it  can  never 
miss  it. 

When  economy  is  an  object  the  bassinet  could  be  dis- 
pensed with  and  a  crib  used  from  birth,  if  the  sides  are 
lined  to  cut  off  draughts  and  the  child  is  properly  sup- 
ported with  pillows  at  the  sides.  In  any  case,  when  the 
baby  is  eight  or  nine  months  old  it  should  be  transferred 
to  a  crib  (Fig.  53),  in  which  it  should  sleep  until  five 
years  of  age.  The  crib  is  best  made  of  white  enamelled 
iron,  and  should  have  sides  which  let  down  on  hinges 
or  on  slides,  and  which  should  be  high  enough  to  pre- 


174 


THE    CARE    OF   THE  BABY. 


vent  falling  out,  for  it  is  astonishing  over  what  high 
vSides  a  small  child  can  climb.  The  hinged  side  takes 
up  much  more  room  in  opening,  and  the  sliding  variety 


Fig.  53. — Iron   crib  with  drop  sides. 

is  consequently  more  convenient  if  it  is  so  made  that 
the  child  cannot  by  any  means  let  it  down  upon  its 
arms  or  legs.  The  old-fashioned  trundle-bed  is  faulty, 
as  it  brings  the  child  too  near  the  draughts  on  the 
floor.  The  crib  is,  as  a  rule,  better  without  curtains.  It 
should  be  provided  with  a  woven-wire  mattress,  and  this 
should  be  as  high  from  the  floor  as  in  an  ordinary  bed. 
The  remaining  contents  and  the  manner  of  making  up 
the  bed  are  the  same  as  for  the  bassinet,  and  the  one  de- 
scription answers  for  both.  There  should  be,  namely,  a 
soft,  thin  hair  mattress,  which  is  decidedly  better  for  strong 
children  than  one  of  feathers  is,  as  the  latter  is  much  too 
warm.     Over  this  is  laid  a  rubber  cloth,  and  the  whole 


SLEEP.  175 

is  covered  by  a  doubled  sheet.  Sometimes  a  quilted  bed- 
cover may  be  put  over  the  rubber,  to  increase  the  softness 
and  warmth.  This  is  a  very  good  plan  in  winter.  It  is 
also  sometimes  well  to  place  a  small  pad,  like  the  lap- 
protector  previously  described  (page  loi),  directly  under 
the  baby,  over  the  sheet.  There  should  be  a  small,  soft, 
thin  feather  pillow  covered  with  a  fine  linen  pillow-slip. 
In  summer  a  pillow  of  curled  hair  is  cooler.  The  cov- 
erings of  the  baby  in  bed  consist  of  a  sheet,  as  many  soft 
blankets  as  the  season  requires,  and  a  light  spread.  In 
cold  weather  an  eiderdown  quilt  is  very  useful.  All  the 
coverings  should  be  light  in  weight,  yet  warm.  The 
sheet  should  be  of  muslin  rather  than  of  linen,  as  there 
is  a  coldness  about  the  latter  which  it  is  very  difficult  to 
overcome.  The  pillow-cases,  however,  are  better  made 
of  linen. 

We  must  constantly  bear  in  mind  the  very  great  im- 
portance of  properly  airing  the  bed  after  it  has  been  slept 
in,  and  of  warming  it  before  it  is  used  again.  Every 
morning  the  windows  of  the  room  should  be  opened  and 
the  bed-covers  be  stripped  off,  and,  with  the  mattress, 
exposed  to  the  air  and  sun  for  at  least  two  hours.  Before 
the  child  is  put  to  bed  in  the  evening  the  covers  should 
be  well  pulled  down  and  allowed  to  stay  so  for  half  an 
hour  or  more.  In  cold  weather  the  sheets  should  be 
taken  off  and  warmed.  Indeed,  it  is  a  good  plan  to  warm 
them  at  all  seasons  except  in  the  height  of  summer.  If 
this  is  done,  there  is  no  necessity  for  a  child  to  sleep 
between  blankets,  unless,  possibly,  in  earliest  infancy. 
It  is  difficult  to  keep  blankets  fresh  and  sweet  if  used  in 
this  way.  If  the  sheets  become  soiled,  they  must  be 
changed  at  once,  no  matter  how  often  the  soiling  occurs. 
It  is  important  to  keep  the  rubber  cloth  well  cleaned  and 
aired. 


176  THE    CARE    OF   THE  BABY. 

The  great  disposition  evinced  by  most  children  to 
wriggle  themselves  outside  of  the  bed-clothes  renders 
something  to  prevent  this  desirable.  There  are  many 
bed-clothes  fasteners  described,  but  as  simple  a  form  as 
any  consists  of  two  short  pieces  of  elastic,  which  are 
attached  to  the  covers  by  a  clamp  and  are  fastened  to  the 
side  of  the  bed  or  crib  by  pieces  of  ribbon,  one  on  each 
side.  This  plan  is  rather  better  than  that  of  pinning  the 
covers  to  the  pillows  with  large  safety  pins,  since  the 
elastic  allows  of  a  certain  deo;-ree  of  turnins:  and  moving 
about.  Even  in  the  earlier  days  of  life  care  must  be 
taken  that  the  head  is  not  covered  by  the  bed-clothing, 
as  otherwise  sufficient  fresh  air  is  not  obtained.  While 
keeping  the  child  warmly  enough  covered  it  is  equally 
important  not  to  make  it  too  warm.  This  is  a  fault  many 
mothers  have.  The  cooling  of  the  hands  and  feet  may 
warn  us  against  too  little  covering,  and  free  perspiration 
against  the  reverse. 

Where  the  child  shall  sleep  at  night  is  a  matter  de- 
pending largely  upon  circumstances.  The  best  plan, 
theoretically,  is  that  which  places  the  baby,  after  the  first 
few  weeks,  with  its  nurse  in  the  night  nursery.  If  the 
child  is  nourished  at  the  breast,  it  can  be  brought  to  the 
mother's  room  at  the  proper  hours  and  then  be  taken 
back.  This  relieves  the  mother  of  care  during  the  night. 
If  it  is  bottle-fed,  the  nurse  gives  it  its  nourishment. 
Many  a  mother,  however,  is  naturally,  and  with  good 
reason,  unwilling  to  entrust  so  much  responsibility  to  any 
employed  person,  while  in  other  cases  the  means  of  the 
parents  or  the  rooms  of  the  house  do  not  permit  of  such 
an  arrangement,  and  the  baby  has  to  sleep  in  the 
mother's  room.  After  the  age  of  a  year,  however,  it 
should  certainly  have  a  separate  room  at  night  if  pos- 
sible.    The  morning  and  afternoon  naps  are  to  be  taken 


EXERCISE   AND    TRAINING.  1 7/ 

in  the  room  used  for  sleeping  in  at  night.  The  tempera- 
ture and  the  furniture  of  the  sleeping-room  are  considered 
under  the  head  of  the  Night  Nursery. 


CHAPTER    VIII. 

EXERCISE  AND   TRAINING,  PHYSICAL,   MENTAL,  AND 

MORAL. 

The  training  of  the  baby,  physically,  mentally,  and 
morally,  is  so  large  a  subject  that  we  can  consider  only 
its  most  salient  points. 

For  the  first  two  weeks  of  life  the  baby  takes  very  little 
physical  exercise,  but  after  this  it  begins  to  kick  and  to 
move  its  arms  about  in  a  way  which  ensures  plenty  of  it, 
if  only  its  clothes  are  of  such  a  nature  that  the  move- 
ments are  not  impeded.  At  the  age  of  two  weeks  the 
child  may  be  systematically  carried  about  in  the  arms 
two  or  three  times  a  day,  as  a  means  of  furnishing 
additional  change  of  position.  We  must  bear  in  mind  that 
its  spine  is  still  very  weak,  and  that  it  must  be  supported 
in  a  proper  manner.  In  lifting  the  baby  the  clothing 
with  the  lower  portion  of  the  body  is  raised  well  with  one 
hand,  the  other  then  slid  under  the  back  and  head,  and 
the  child  raised  on  the  outspread  palms.  The  young 
infant  should  not  be  grasped  around  the  chest.  It  should 
at  first  be  carried  on  its  back  upon  a  pillow  on  the  nurse's 
arm,  although  after  it  is  a  month  old  the  pillow  may  be 
dispensed  with.  When  three  or  four  months  old,  and  up 
to  the  age  of  six  or  eight  months,  it  may  be  seated  up- 
right upon  the  arm,  with  the  hand  of  the  other  side  sup- 
porting its  head  and  back  carefully,  although  as  the  age 
advances  this  support  is  not  always  necessary.     As  the 

12 


178  THE    CARE    OF   THE   BABY. 

back  bends  very  easily  in  any  direction  in  infancy,  we 
must  guard  against  any  permanent  curvature  developing 
by  seeing  that  tbe  child  is  carried  sometimes  on  one  arm 
and  sometimes  on  the  other. 

Closely  connected  with  the  exercising  of  the  baby  is 
its  exposure  to  the  outdoor  air.  Although  this  is  often 
of  much  benefit,  it  is  a  mistake  to  be  in  too  great  a  hurry 
with  the  process  of  "hardening,"  so  called,  since  this 
frequently  only  succeeds  in  making  the  child  ill,  just  as 
pampering  makes  it  delicate.  No  absolute  rule  can  be 
given  for  the  date  at  which  the  baby  shall  be  taken  out 
for  the  first  time.  If  at  the  age  of  two  weeks  it  is  well 
and  is  properly  protected,  the  nurse  when  walking  with 
it  may  carry  it  into  another  room  of  a  somewhat  cooler 
temperature.  This  will  give  quite  sufficient  change  of 
air.  By  the  time  it  is  a  month  old,  or  even  before  this, 
it  may  be  taken  into  the  open  air  in  summer-time,  and 
kept  there  for  ten  or  twenty  minutes  on  the  first  visit, 
and  longer  on  subsequent  ones.  In  midwinter  it  is  better 
to  delay  longer,  and  not  to  make  the  first  excursion  out 
of  doors  until  the  age  of  two  or  possibly  three  months. 
There  is  no  doubt  that  it  is  sometimes  still  wiser  to  wait 
until  spring  if  the  baby  has  been  born  in  the  winter 
season,  but  this  must  be  determined  largely  by  circum- 
stances and  for  each  individual  case.  An  autumn  baby 
ought,  if  possible,  to  go  out  before  winter  sets  in,  and 
then  to  continue  to  do  this  on  all  good  days.  It  is  im- 
portant to  choose  carefully  the  hours  best  suited  for  the 
daily  outing.  In  summer,  almost  any  hour  will  answer 
between  seven  or  eight  in  the  morning  and  sunset.  In 
winter,  on  the  other  hand,  hours  from  ten  to  three  are 
the  best.  The  morning  hours  especially  are  to  be  pre- 
ferred, as  a  rule,  because  so  many  days  which  open  pro- 
pitiously become  cloudy  by  early  afternoon,  and  the  baby 


EXERCISE  AND    TRAINING.  1 79 

may  miss  its  outing  altogether  if  the  morning  is  not  taken 
advantage  of.  An  exception  to  the  hours  recommended 
occurs  on  extremely  hot  days  in  summer.  The  middle 
of  the  day  is  then  far  too  hot,  and  the  early  morning  and 
late  afternoon,  or  even  the  evening,  are  to  be  given  the 
preference. 

Damp,  windy,  or  very  cold  days  are  always  to  be 
avoided  during  the  early  months  of  life,  and  even  after 
this  period  exposure  to  them  is  of  questionable  advantage, 
for  we  have  always  to  balance  the  good  that  may  come 
from  the  outing  against  the  harm  that  may  result  from 
the  unfavorable  weather.  It  is  a  mistaken  idea  that 
every  child  must  be  in  the  open  air  every  day,  no  matter 
what  the  nature  of  the  weather  may  be.  Even  on  the 
best  days  it  is  important  to  avoid  chilling  and  to  keep  a 
close  watch  over  the  condition  of  the  hands  and  feet. 
The  least  chilliness  of  these  is  a  warning  to  go  in. 

One  plan  which  can  be  safely  adopted  with  autumn  or 
winter  babies  is  that  of  opening  the  windows  in  one  of 
the  rooms  of  the  house,  wrapping  the  baby  thoroughly, 
and  walking  with  it  in  this  room  for  half  an  hour  or  so, 
just  as  though  it  were  out  of  doors.  This  may  be  begun 
when  it  is  about  a  month  old.  The  windows  should  at 
first  be  shut  down  before  the  baby  is  taken  into  the  room, 
but  later  they  may  be  left  open  if  the  weather  is  not  too 
cold.     Of  course,  draughts  must  be  avoided. 

The  first  going  out  should  be  in  the  nurse's  arms,  since 
the  heat  of  her  body  keeps  the  child  warm,  and  the  sup- 
port of  her  arm  and  hand  renders  it  much  more  comfort- 
able. After  the  age  of  three  or  four  months,  depending 
on  the  season,  it  may  be  taken  out  in  a  perambulator, 
and  remain  out  much  of  the  day  if  the  temperature  is 
warm. 

The  choice  of  the  perambulator  and  the  manner  in 


1 80  THE    CARE    OF   THE  BABY. 

which  it  shall  be  used  are  matters  of  much  importance. 
The  perambulator  should  be  well  balanced,  so  that 
there  is  no  danger  of  it  tipping  over  backward,  and 
should  especially  have  easy  springs,  in  order  to  save  the 
baby  as  far  as  possible  from  the  results  of  careless  wheel- 
ing. It  should  be  provided  with  an  adjustable  seat  for 
use  when  the  child  begins  to  sit  up.  It  should  also  have 
a  detachable  overhanging  sun-shade  or  adjustable  hood 
for  use  in  the  sun.  It  is  necessary,  too,  to  see  that  this  is 
always  taken  with  the  carriage  and  is  always  used  when 
needed,  for  nothing  is  more  common  than  to  find  a  care- 
less nurse  wheeling  a  baby  with  the  sun  full  in  its  face. 
The  color  of  the  shade,  or  rather  of  its  lining,  is  a  very 
important  matter  too  often  overlooked.  One  which  is 
white  or  of  some  bright  color,  such  as  red  or  yellow,  m.ay 
seriously  injure  the  eyes,  for  it  reflects  into  them  the 
glare  from  the  ground.  The  lining,  at  least,  ought  to  be 
of  some  dark  color,  such  as  green  or  brown.  The  car- 
riage should  be  provided  wuth  a  soft  warm  bed  and  with 
warm  covers  and  a  pillow.  A  knitted  or  crocheted  afghan 
is  a  serviceable  article.  For  use  in  summer,  mattresses 
and  pillows  of  hair  are  much  cooler  than  those  of  feathers. 
The  question  often  arises  whether  it  is  harmful  to  allow 
an  infant  to  sleep  out  of  doors.  There  is  nothing  to  be 
feared  from  it,  and  no  infant  should  be  brought  in  merely 
because  it  drops  asleep  in  its  coach.  In  exceptional  cases 
it  may  even  be  well  to  allow  the  regular  daily  naps  to  be 
taken  out  of  doors. 

As  the  baby  grows  more  active  there  is  ver}^  great  dan- 
ger of  its  falling  out  of  its  carriage.  To  prevent  this 
accident  most  perambulators  are  provided  with  a  straight 
strap  in  front  of  the  child.  This  is  often  very  unsatisfac- 
tor}',  since  it  does  not  keep  the  child  either  from  climbing 
over,  if  active,  or  from  being  thrown  out  in  case  of  acci- 


EXERCISE  AND    TRAINING. 


I8I 


Fig.  54. — Strap  for  coach. 

plan   to   place   the 


dent.  Some  really  serviceable  preventive  of  this  very 
real  danger  of  falling  is  required,  and  a  very  good  form 
is  that  shown  in  the  illustration.  This  consists  of  a  strap 
which  goes  entirely  around  the  waist,  and  is  attached  by 
smaller  straps  to  the  sides  of  the  carriage  (Fig.  54). 

A  child  that  has  reached  the  age  of  six  months  will 
no  longer  be  content  to  lie  flat  in  its  carriage.  It  is  then 
necessary  to  see  that  it  is  well 
supported  with  extra  pillows 
at  the  back  and  sides.  For 
children  of  this  agfe,  or  for 
older  ones  who  can  sit  easily 
without  support,  the  adjusta- 
ble seat  should  be  placed  in 
the  coach. 

From  the  age  of  three 
months  onward  it  is  an  excellent 
baby  at  times  upon  a  blanket  or  mattress  in  some 
place  in  the  room  which  is  free  from  draughts,  and 
so  to-  arrange  its  clothing  that  it  is  allowed  to  make 
freely  all  the  motions  of  which  it  is  capable.  This 
gives  it  a  good  chance  to  learn  to  stand  or  to  creep  as 
soon  as  it  reaches  the  age  for  it.  A  clothes-basket  or 
large  box  padded  with  soft  material  makes  a  good  place 
for  this  early  exercise.  Sitting  up  for  too  long  a  time 
must  be  guarded  against  throughout  the  first  year,  and 
even  after  this  lying  down  a  good  part  of  the  time  should 
be  encouraged.  Whether  or  not  the  child  shall  creep 
upon  the  floor  depends  on  circumstances.  In  winter 
the  lowest  layer  of  air  is  very  apt  to  be  cool,  and  in 
severe  weather  the  use  of  the  floor  is  almost  out  of  the 
question,  even  though  the  nurser}-  has  comparatively  few 
draughts.  So,  too,  if  a  child  has  a  cold,  it  had  better  be 
kept  off  the  floor  until  well  again.     The  creeping  apron 


l82 


THE   CARE   OF  THE  BABY. 


described  elsewhere  is  very  serviceable  for  keeping  the 
air  from  the  child.  To  prevent  a  creeping  child  from 
reaching  unsuitable  parts  of  the  room  it  is  a  good  plan  to 
place  it  within  a  small  portable  pen.  The  portions  of  the 
fence  are  separable,  so  that  the  whole  can  be  put  away 
in  small  compass  when  not  in  use.  Pens  of  this  kind 
can  be  bought  or  can  easily  be  made  (Fig.  55). 

Efforts  at  walking  give  the  baby  abundance  of  a  new 
kind  of  exercise,  and  we  must  take  particular  heed  that 
it  is  not  overdone.     Too  much  cannot  be  said  in  favor  of 


Fig.  55. — Creeping  pen. 

letting  the  baby  take  its  own  time  in  making  the  new 
acquisition.  No  appliances  to  aid  walking  should  be  used, 
and  the  child  should  not  be  urged  at  all.  The  advisabil- 
ity of  using  "  baby -jumpers  "  or  "baby  tenders"  is  very 
questionable.  They  may  perhaps  be  of  service  for  a 
heavy  infant  who  insists  on  learning  to  be  on  his  legs, 
yet  who  is  in  danger  of  getting  bow-legged  in  conse- 
quence. Yet  it  is  better,  if  there  seems  to  be  a  tendency 
for  the  legs  or  ankles  to  bend,  to  discourage  walking  en- 
tirely, for  it  is  much  easier  to  prevent  the  deformity  than 
to  correct  it.  At  this  period  of  life  the  child  should  still 
be  kept  in  the  perambulator  during  the  daily  airing,  but 
later,  when  it  has  learned  to  walk  pretty  well,  it  may 


EXERCISE  AND    TRAINING.  1 83 

have  ten  or  fifteen  minutes'  additional  outdoor  exercise 
on  its  feet.  Gradually  the  duration  of  the  outdoor  walk 
may  be  increased,  but  the  perambulator  must  still  be 
used  for  most  of  the  time  until  the  child  is  two  and  a 
half  or  three  years  old.  A  half  mile  at  the  most  is  quite 
sufficient,  and  often  more  than  enough,  for  a  walk  at  this 
age. 

Sometimes  children  who  have  outgrown  the  peram- 
bulator will  ride  with  pleasure  in  a  "play"  express- 
wagon  or,  in  winter,  on  a  sled.  The  little  go-carts 
for  children,  made  in  various  designs,  and  known  by 
various  names,   such  as  "jaunting  car,"    "mail  cart," 


Fig.  56.— Go-cart. 

"chair  car,"  and  the  like  (Fig.  56),  are  serviceable  for 
children  over  a  year  of  age.  They  are  made  of  board  or 
of  rattan.  Certainly  some  vehicle  ought  to  be  ready  at 
hand  at  this  period  of  life.  We  are  too  prone  to  forget 
how  short  the  legs  of  little  children  are,  and  how  easily 
their  strength  is  exhausted. 


184  THE   CARE    OF  THE  BABY. 

There  is  one  form  of  compulsory  exercise  which  should 
be  carefully  avoided.  I  refer  to  the  trotting  on  the 
knee  which  is  so  common  with  many  nurses.  When  one 
compares  the  diminutive  size  of  the  baby,  lying  on  its 
back  or  stomach  in  the  nurse's  lap,  with  the  vigor  of  the 
trotting  to  which  it  is  subjected,  there  can  be  no  surprise 
awakened  if  vomiting  and  other  disturbances  of  digestion 
are  produced.  Even  should  these  not  occur,  the  habit  is 
a  bad  one,  since  the  baby  may  gradually  become  accus- 
tomed even  to  this  hard  usage,  and  learn  to  depend  on  it 
for  being  put  to  sleep,  just  as  it  will  depend  on  singing 
or  rocking  when  used  for  this  purpose. 

In  this  connection  we  may  leave  for  a  moment  the 
exercise  of  the  body-muscles  in  general  to  consider  the 
training  of  certain  others — namely,  those  which  control 
the  emptying  of  the  bladder  and  the  bowels.  By  the  time 
it  is  three  months  old  the  baby  becomes  conscious  of  these 
acts,  and  even  before  this  early  age  its  education  may  be 
begun.  It  is  most  liable  to  empty  its  bladder  soon  after 
a  meal,  and  to  open  its  bowels  with  some  regularity  as  to 
time.  If  the  mother  will  hold  it  over  a  receptacle  on  her 
lap  a  little  while  before  either  evacuation  is  expected, 
the  child  will  very  gradually  learn  to  recognize  the  pur- 
pose of  the  procedure  and  will  act  accordingly.  As  the 
baby  grows  old  enough  to  sit  up,  even  though  partially 
supported,  it  may  be  placed  in  the  nursery  chair  at  the 
proper  time,  and  always  with  the  greatest  regularity  as  to 
the  hour.  Patience  and  perseverance  will  accomplish  the 
desired  teaching  at  last.  It  scarcely  need  be  remarked 
that  punishment  for  delinquencies  in  this  line  is  totally 
out  of  the  question  at  any  age.  Of  course,  children  dif- 
fer in  the  rapidity  with  which  they  learn  this  control. 
Many  have  accomplished  it  by  the  age  of  a  year;  most 
should  have  done   so   by  eighteen   months  of  age;   all 


EXERCISE  AND    TRAINING.  1 85 

ought  to  have  learned  it  by  the  end  of  the  second  year  at 
latest,  and  some  may  be  trusted  during  the  day  when  six 
months  old,  or  even  considerably  less  than  this.  The 
control  is  always  decidedly  less  during  the  night. 

With  increasing  age  children  become  able  to  take  with- 
out fatigue  an  amount  of  exercise  which  is  really  aston- 
ishing.   Still,  there  is  the  necessity  of  guarding  constantly 
against  an  excess  of  it  in  the  excitement  of  play,  as  well 
as  of  seeing  that  every  portion  of  the  body  shares  in  it. 
Rolling  hoop  can  be  begun  by  quite  young  children,  and 
the  use  of  a  rocking-horse  is  valuable  for  exercise  in  the 
nursery.     A  velocipede  which  cannot  be  upset  will  be  of 
service  as  soon  as  a  child  is  old  enough  to  use  it.     For 
older  children  dancing  is  a  useful  indoor  exercise  if  done  in 
moderation  and  with  proper  precautions  against  late  hours 
and  taking  cold.     The  objections  so  often  urged  against 
skipping  rope  are  in  no  way  valid  unless  the  exercise  is 
indulged  in  to  great  excess.     After  the  age  of  puberty, 
however,  it  may  be  harmful  to  delicate  girls.     Skating, 
especially  on  ice,  is  excellent,  under  proper  precautions,' 
for  both  boys  and  girls.     There  is,  of  course,  the  risk 
of  falls,  but  no  active  sports  are  unattended  by  some  ele- 
ment of  danger.    The  art  of  swimming  should  be  acquired 
by  every  child,  not  only  for  the  exercise  which  it  gives, 
but  also  for  the  safety  which  it  may  some  time  ensure. 
The  use  of  the  bicycle  is  to  be  commended,  provided  the 
guiding  apparatus  be  of  such  a  height  and  so  placed 
that  the  child  cannot  stoop  over  in  the  position  so  gener- 
ally assumed  by  bicyclists,  and  provided  that  this  form  of 
exercise  be  not  employed  too  exclusively;  for  although 
the  lower  extremities  are  well  used,  the  upper  ones  are 
not  sufficiently  so,  and  the  position,  of  the  arms  tends  to 
contract  the  chest.    Tennis  and  other  outdoor  games  may 
be  indulged  in  freely.     Nothing  can  be  better  for  chil- 


1 86  THE   CARE    OF  THE  BABY. 

dreti  than  riding,  first  on  a  donkey  or  pony,  and  later  on 
a  horse — the  girls,  of  course,  riding  astride,  just  as  the 
boys  do.  Indeed,  none  of  these  outdoor  sports  are 
intended  for  boys  alone,  and  girls  should  be  encouraged 
to  take  part  in  all  of  them.  Many  a  woman  has  to  thank 
her  romping,  outdoor  girl-life  for  the  robust  health  which 
she  afterwards  enjoys.  Let  the  girl  be  a  hoyden  just  as 
long  as  she  pleases — the  longer  the  better.  Sedentary 
indoor  amusements  should,  in  fact,  be  discouraged.  It 
is  much  easier  to  tone  her  down  and  "  make  a  lady  "  of 
her  after  a  while  than  it  is  to  tone  her  up  if  she  has  no 
good  constitution  on  which  to  build.  A  girl  grows  into 
a  "  thing  of  beauty  "  only  if  of  sound  health. 

A  city-bred  child,  however,  has  little  opportunity  of 
taking  the  necessary  amount  of  exercise  of  any  kind, 
unless  a  park  or  an  open  square  be  somewhere  in  the 
vicinity.  It  is  consequently  of  the  greatest  benefit  to 
take  growing  children  to  the  country,  mountains,  or  sea- 
side for  as  much  as  possible  of  the  warmer  season  of  the 
year.  Places  which  are  merely  fashionable  resorts  are 
not  suitable  unless  the  children  are  in  no  way  trammelled 
by  the  restrictions  from  which  their   elders  suffer. 

We  must  never  forget  that  many  children  are  disposed 
to  exercise  far  beyond  their  strength,  especially  under  the 
excitement  of  play  with  a  number  of  companions.  They 
show  no  judgment  in  the  matter,  and  do  not  realize, they 
are  tired  until  worn  out.  Over  such  children  a  careful 
supervision  must  be  kept,  and  an  enforced  hour  of  resting, 
if  possible  lying  down,  must  be  insisted  on  some  time 
during  every  day. 

Even  though  plenty  of  exercise  can  be  had  in  summer, 
the  inclemency  of  the  weather  in  winter  often  presents  a 
great  obstacle  to  obtaining  it  at  that  season.  Besides 
this,  the  confinement  of  school-life  in  winter  often  tells 


EXERCISE  AND    TRAINING.  1 87 

upon  the  health  of  the  child.  It  is  now  that  the  well- 
regulated  gymnasium  fills  a  place  taken  by  nothing  else. 
It  would  be  a  wonderful  aid  to  the  formation  of  sound 
health  did  every  child  attend  one  systematically.  It  is 
much  better  to  spend  a  half  hour  or  fifteen  minutes  there 
every  day  than  it  is  to  exercise  for  a  longer  period  only 
two  or  three  times  a  week.  Where  no  gymnasium  is 
available  much  can  be  done  at  home.  One  of  the  best 
methods  for  deleyoping  the  arms  and  chest  consists  in 
swinging  on  a  low  swing  or  hanging  for  a  few  moments 
by  the  arms  from  a  horizontal  bar,  repeating  this  fre- 
quently during  the  day.  Swedish  movements  are  of 
great  value,  and  massage  is  also  of  service,  although  less 
efficient.  The  calisthenic  exercises  now  used  at  many 
schools  are  to  be  recommended  highly.  It  is  especially 
useful  in  the  case  of  young  children  to  have  such  exer- 
cise accompanied  by  music,  as  it  makes  it  of  greater 
interest. 

The  various  sports  which  have  been  referred  to  of 
course  come  under  the  head  of  Amnsemeizfs  also,  and 
exercise  the  mind  as  well  as  the  body.  Childhood  is 
often  called  "  the  play- time  of  life."  The  chief  occupa- 
tion of  the  child  is  to  play,  and  everything  else  must  be 
made  subservient  to  this.  The  training  of  the  mind  can 
be  combined  with  it,  but  should  always  hold  a  secondary 
place,  for  there  is  little  use  of  a  sound  mind,  and  little 
chance  of  getting  it,  unless  the  body,  too,  be  sound. 
Still,  while  the  child  is  playing  it  is  learning,  and  the 
acquiring  of  knowledge  commences  often  before  we  have 
any  idea  of  it.  As  we  cannot  hinder  the  learning,  we 
must  early  begin  to  superintend  it,  and  to  guide  the 
baby  in  its  amusements,  as  well  as  in  other  things,  in  a 
line  which  will  instruct  both  its  mind  and  its  moral  sense. 

We  can  in  the  limits  of  this  chapter  merely  touch  on 


1 88  THE   CARE    OF  THE  BABY. 

some  of  the  matters  connected  with  the  viental  and  moral 
traini7ig.  This  cannot  be  commenced  too  early.  Even 
by  the  age  of  three  months  the  infant  shows  evidence  of 
developing  a  will  of  its  own,  which  will  soon  dominate 
the  parents  unless  kept  in  check.  Early  in  life  the  baby 
needs  very  little  diversion.  Indeed,  up  to  the  age  of  five 
or  six  months,  the  child  should  not  be  played  with  at 
all,  and  even  later  all  playing  before  the  hour  for  sleep 
must  be  avoided.  Before  this  age  it  does  not  require 
playthings,  but  now  it  may  be  amused  by  a  rubber  rattle, 
or  other  toys  which  make  a  noise,  a  rubber  doll,  or  a 
bright-colored  worsted  ball.  We  must  bear  in  mind  the 
necessity  of  cleansing  thoroughly  and  frequently  the 
rubber  toys  which  an  infant  is  constantly  putting  into  its 
mouth.  No  toy  should  be  given  which  can  frighten  by 
sudden  movements  or  startle  by  noises.  Eater  the  child 
needs  more  toys  to  be  used  in  the  house  on  rainy  days, 
and  others  which  it  can  play  with  out  of  doors.  A  heap 
of  clean  sea  sand  will  furnish  a  child  of  two  or  three  years 
an  unending  source  of  amusement. 

It  should  not  be  forgotten  that  it  is  not  only  a  foolish 
extravagance  to  load  a  child  of  any  age  with  expensive 
and  fragile  toys,  but  that  it  is  distinctly  prejudicial  also. 
Always  looking  for  something  new,  the  child  soon 
becomes  discontented  with  the  things  it  has,  no  matter 
how  fresh  and  good  they  may  be.  Eack  of  valuation,  too, 
breeds  lack  of  care  of  the  playthings.  Simplicity  in  de- 
sires will  better  be  attained  by  having  only  a  few  simple 
toys,  although  certain  others  may  be  kept  in  reserve  and 
be  given  only  on  special  occasions  or  as  a  special  favor 
or  reward  which  has  been  well  earned.  Habits  of  neat- 
ness can  be  taught  in  the  use  of  playthings,  and  even 
when  small  a  child  can  learn  the  lesson  of  "  a  place  for 
everything."       Toys    may   be   chosen   which    instruct. 


EXERCISE  AND    TRAINING.  1 89 

Picture-books,  Noah's  arks  and  animals,  the  kinder- 
garten toys,  and,  a  little  later,  lettered  blocks,  are  of  this 
class.  With  the  latter  many  a  child  has  learned  its  letters 
almost  without  effort  or  special  instruction. 

There  is  really  no  hurry  about  teaching  a  child  to 
talk.  Of  course,  the  more  attention  there  is  given  to  the 
matter,  the  sooner  will  most  babies  learn.  The  only 
thing  which  should  be  carefully  borne  in  mind  is  the 
great  folly  of  ever  using  "baby-talk."  It  is  no  more 
comprehensible  to  the  child  and  no  easier  for  the  mother. 
Gibberish  talked  to  the  baby  means  that  it  will  learn 
only  gibberish.  Then  at  an  age  when  it  becomes  a  mor- 
tification to  the  parents  the  child  of  three  or  four  years 
may  still  be  talking  a  nearly  unintelligible  jargon. 

The  constant  questioning  on  the  part  of  children  is 
often  very  trying,  but  should  never  be  rudely  repressed. 
Bear  with  it  patiently,  even  encourage  it;  answer  truth- 
fully all  you  can,  and  remember  how  very  much  there  is 
which  the  child  is  so  anxious  to  learn  all  about.     Of 
course  there  are  times  when  the  questions  are  out  of  place 
and  must  be  gently  checked.     So,  too,  with  the  noise  of 
children:  although  it  is  often  disagreeable  and  needs  to  be 
stopped,  we  must  never  forget  that  to  make  a  noise  is  nat- 
ural, and  not  to  make  it  is  a  thing  which  has  to  be  learned. 
It  is  important   to  remember  that  in  the  instruction 
of  children  example  is  far  more  valuable  than  precept. 
Children  are  wonderful  imitators,  and  their  words  and 
actions  will  be  copied   largely  from   those  with  whom 
they  are  most  intimately  thrown.     If  a  child  is  never 
told  a  falsehood  by  its  parents  or  its  nurse,  and  is  taught 
to  look  upon  it  with  horror,  there  will  be  little  danger'^of 
its  becoming  untruthful.    The  punishing  of  a  child  for  a 
fault  after  it  has  told  the  truth  about  it  is  simply  encour- 
aging it  to  lie  on  the  next  occasion.    We  must  not,  in  this 


190  THE    CARE    OF  THE  BABY. 

connection,  overlook  the  fact  that  the  excess! vety  vivid  im- 
asfination  of  a  child  sometimes  leads  it  to  view  its  fancies 
as  realities.  Thus  it  will  tell  all  manner  of  false  stories 
of  what  it  or  others  have  done  or  said,  and  will  often 
actually  believe  it  all.  This  is  only  a  sort  of  roman- 
cing, and  must  be  sharply  distinguished  from  deliberate 
lying,  with  which  it  has  not  the  slightest  connection. 

The  habit  of  implicit,  unquestioning  obedience  cannot 
be  taught  too  early.  It  is  of  far  too  frequent  occurrence 
for  a  mother  to  tell  her  child  that  if  it  will  obey  some 
command  she  will  buy  it  a  toy  or  reward  it  in  some  other 
way.  There  can  be  no  greater  folly  than  this,  for  the 
little  one  needs  no  great  power  of  reasoning  to  under- 
stand that  the  act  of  obedience  is  thus  made  a  favor  done 
by  it  to  its  parent.  To  obey  because  the  command  is 
given  and  because  the  child  loves  its  parents  should  be 
the  only  reason.  This  does  not  mean  that  a  parent  may 
be  tyrannical,  exacting,  or  unreasonable.  Remember  that 
the  child  may  be  right  and  you  wrong. 

One  should  never  use  threats  or  employ  punishments 
unless  they  are  really  necessary.  Punishment  should  be 
carefully  selected,  never  given  in  anger,  but  in  sorrow, 
and  never  of  a  nature  that  may  frighten  the  child  or 
injure  its  health  in  any  way.  The  boxing  of  the  ears 
may  do  serious  harm,  and  imprisonment  in  dark  closets 
and  similar  punishments  are  equally  dangerous.  When 
a  child  has  been  threatened  with  a  punishment,  and  has, 
in  spite  of  this,  committed  the  forbidden  act,  it  should  not 
fail  to  pay  the  penalty,  else  it  will  soon  learn  to  despise 
its  parents'  commands.  Of  course,  exceptions  arise  where 
justice  must  be  tempered  with  mercy,  but  these  are  to  be 
exceptions  only.  If  parents  would  less  frequently  threaten 
with  punishment  and  less  often  tell  their  children  "<f6';zV," 
but  Sfive  them  something  to  do,  there  would  be  fewer 


EXERCISE  AND    TRAINING.  I9I 

lapses  from  obedience.  Indeed,  the  whole  question  of 
punishment,  of  the  "breaking  the  will"  of  a  child,  and 
so  on,  is  a  perplexing  one,  and  far  too  great  to  be  con- 
sidered here. 

I  have  said  so  much  in  this  connection  about  the  import- 
ance of  obedience  because  its  value  is  especially  great  in 
sickness.  Many  a  time  a  physician  is  rendered  helpless 
to  a  great  extent  because  a  poorly-trained  child  refuses  to 
take  medicine  prescribed  for  it,  except  after  losing  a 
pitched  battle  over  it  and  doing  its  nervous  system  injury 
by  the  struggle. 

A  freedom  from  selfishness  is  a  quality  which  cannot 
be  taught  too  early.  A  child  should  learn  to  think  and 
to  do  for  others,  and  not  for  itself.  This  is  a  difficult 
lesson  to  learn,  for  we  are  all  selfish  by  nature.  It  should 
also  learn  to  have  a  fitting  respect  for  and  to  act  with 
gentleness  and  kindness  to  all  created  things,  whether 
animate  or  inanimate.  A  child  should  never  be  told  to 
"hit  the  bad  floor"  against  which  it  has  struck  its  head. 
This  is  nothing  else  than  teaching  revenge,  to  say  noth- 
ing of  the  foolishness  of  it. 

As  the  child  grows  older  one  of  the  best  means  of  incul- 
cating a  love  for  and  a  sympathy  with  objects  in  nature  is 
to  allow  it  to  have  a  growing  plant  or  a  pet  of  some  kind 
of  which  it  shall  have  the  care.  This  teaches  thoughtful- 
ness  as  well  as  serves  as  an  amusement.  Of  course,  we 
cannot  expect  the  child  to  have  the  whole  responsibility 
of  the  care  of  the  pet,  for  this  is  asking  too  much  of  its 
perseverance  and  enthusiasm.  The  parents  should  assist, 
but  must  not  take  the  whole  care  upon  them.  In  this 
way  the  pet  does  not  become  a  burden  or  a  source  of  ill- 
advised  reproaches. 

I  must  strongly  advise  against  the  common  habit  of 
making  the  baby  the  centre  of  an  admiring  circle  of  vis- 


192  THE    CARE    OF   THE   BABY. 

itors.  The  baby  should  see  just  enough  of  company  to 
teach  it  to  be  free  from  a  dread  of  strangers.  As  a  rule, 
however,  it  should  not  be  brought  into  the  parlor.  The 
custom  not  only  bores  the  visitors,  too  polite  to  say  so, 
but  it  excites  the  baby  far  too  much.  A  little  later  this 
course  results  in  the  development  of  a  forward  child  who 
is  always  "showing  off"  or  interrupting  the  conversa- 
tion of  its  elders.  Children's  parties,  too,  are  far  too 
exciting  for  babies,  and  even  in  early  and  later  childhood 
they  should  be  of  rare  occurrence  and  simple  in  their 
arrangements,  and  be  held  in  the  very  early  evening  or 
late  afternoon. 

Much  harm,  sometimes  irreparable,  is  often  done  by 
allowing  a  child  to  grow  up  almost  entirely  in  the  society 
of  domestics.  If  parents  want  children  to  learn  pleasing 
and  polite  manners,  the  use  of  good  English,  and  refined 
modes  of  eating,  they  must  associate  their  children  with 
themselves;  and  if  they  themselves  do  not  possess  these 
qualities,  they  should  cultivate  them  as  thoroughly  and 
rapidly  as  possible.  In  the  effort  to  teach  the  child  in 
these  respects  they  may  profitably  let  it  appear  at  the 
general  table  as  soon  as  it  reaches  the  age  of  two  and  a 
half  or  three  years,  or  at  the  most  four  years,  unless 
company  is  present.  In  many  cases,  however,  children 
behave  much  better  and  are  more  easily  trained  and 
managed  if  their  meals  are  given  to  them  at  their  own 
little  tables  in  the  nursery.  Much  depends  on  circum- 
stances. It  is  a  valuable  safeguard  against  a  child 
pushing  its  chair  over  to  have  this  fastened  in  some  way 
to  the  table. 

Very  early  we  should  begin  to  teach  a  child  not  to 
have  unreasoning  fear;  and  one  of  the  best  means  of 
accomplishing  this  is  never  to  let  it  be  frightened.  Such 
toys  as  the  jack-in-the-box  and  those  which  make  a  sud- 


EXERCISE  AND    TRAINING.  193 

den  loud  noise  should  not  be  given  to  very  young  chil- 
dren, as  they  may  be  the  cause  of  great  fright.  A 
child  should  be  taught  to  have  no  fear  of  such  things 
as  mice,  worms,  and  other  innocent  animals.  It  should 
look  upon  the  dark  as  equally  harmless  with  the  light. 

Too  great  caution  cannot  be  used  in  the  choice  of 
stories  told  or  read  to  little  children,  since  they  sometimes 
gather  from  what  seems  to  be  least  harmful  the  occasion 
of  a  timidity  not  easily  recovered  from.  Ghost-stories 
are,  of  course,  entirely  out  of  the  question.  They  have 
often  been  the  cause  of  untold  mental  suffering  and  of  a 
fear  which  a  lifetime  has  not  overcome.  Many  of  the 
popular  fairy  and  other  stories  are  quite  capable  of  fright- 
ening nervous  children.  The  fierce  wolf  of  "  Little  Red 
Riding  Hood,"  the  frightful  giants  of  "Jack,  the  Giant 
Killer,"  the  harsh,  unkind  stepmother  of  "Cinderella," 
and  the  sad  loneliness  of  the  deserted  "  Babes  in  the 
Woods, ' '  may  readily  return  as  real  terrors  after  the  little 
one  has  been  put  to  bed.  Even  stories  which  excite  the 
imagination  too  vividly  are  to  be  avoided,  although  they 
may  be  entirely  free  from  elements  causing  alarm. 

Up  to  the  age  of  nine  or  ten  years  boys  and  girls  are 
disposed  to  play  together  unless  some  too  officious  person 
has  made  the  boys  dislike  the  girls'  games,  and  the  girls 
feel  that  the  boys  are  rough  and  "  horrid."  No  hinder- 
ance  should  be  opposed  to  this  joining  in  play,  since  it 
induces  the  girls  to  lead  an  active  life.  The  mother 
should  never  forget,  however,  that  it  is  important  to  ex- 
ercise careful  although  unobserved  supervision  over  the 
morals  of  the  children,  whether  the  sexes  play  together 
or  separately,  since  even  those  who  appear  perfectly  in- 
nocent are  by  no  means  always  so;  nor  is  it  invariably 
some  one  else's  children  who  are  at  fault.  Experience 
shows  that  almost  no  age  is  too  young  to  need  the  sub- 
jection to  this  watchfulness, 

13 


194  THE    CARE    OF   THE   BABY. 

Finally,  we  must  consider  briefly  the  management  of 
the  school-life  of  children.  With  the  comparatively 
recent  improvements  in  schooling,  children  may  be  sent 
to  a  kindergarten  by  the  age  of  three  or  four  years.  The 
key-note  of  the  kindergarten  is  the  acquiring  of  know- 
ledge by  play.  At  the  same  time  the  child  is  amused  and 
learns  a  certain  degree  of  discipline  and  order.  Many  of 
the  games  are  accompanied  by  little  songs  and  move- 
ments of  the  body,  which  are  always  designed  to  impart 
knowlege  of  some  sort.  Thus  the  child  sings  of  the 
flight  of  birds,  and  imitates  the  flying  by  the  motion  of 
the  arms.  It  learns  also  of  the  harmony  of  colors  by 
weaving  colored  papers,  and  gains  manual  dexterity  at 
the  same  time.  A  knowledge  of  number  and  of  form 
comes  from  playing  with  blocks.  A  grain  of  corn  may 
be  the  text  for  a  story  about  growth,  and  the  child  learns 
a  song  regarding  this. 

These  instances  illustrate  imperfectly  the  methods  of 
the  kindergarten.  Whenever  a  good  school  of  the  kind  is 
available,  it  should  be  utilized,  and  Avhen  it  is  not,  the 
mother  should  herself  devote  some  time  daily  to  instruct- 
ing her  child  on  the  lines  indicated.  There  are  now 
many  excellent  manuals  on  kindergarten  instruction 
which  give  details  of  the  method  of  teaching.  But  with 
some  children  even  the  simple  instruction  of  the  kinder- 
garten may  give  too  much  mental  work;  for  the  learning 
of  songs  and  rhymes  is,  of  course,  a  decided  mental 
effort. 

There  is  really  no  need  to  teach  a  child  to  read  before 
the  age  of  six  years.  Precocity  is  not  a  thing  to  be 
desired.  Indeed,  in  delicate  children  it  is  to  be  dis- 
couraged strongly.  It  is  not  the  slightest  indication  of 
talent  or  genius.  Many  children  teach  themselves  their 
letters,  as  has  already  been  mentioned:  many  go  further. 


EXERCISE  AND    TRAINING.  1 95 

and  learn  to  read  with  very  little  assistance  if  they  have 
once  been  given  the  start;  while  still  other  children  find 
study  always  a  burden.  If  we  have  succeeded  in  getting 
the  power  of  observation  and  attention  well  cultivated 
by  the  kindergarten  object-lesson  methods,  reading  will 
usually  come  readily  enough. 

By  the  time  the  child  is  six  or  seven  years  old  it  may 
be  given  some  regular  lessons  and  do  some  actual  study, 
but  not  at  the  expense  of  health,  and  the  hours  should 
be  very  short.  Three  or  four  .hours  daily  are  quite 
enough  up  to  the  age  of  ten  years.  Throughout  the 
early  school-life  there  should  be  no  studies  to  prepare  at 
home,  for  the  confinement  of  the  school-hours  is  all  that, 
and  often  more  than,  the  health  can  stand.  The  great 
fault  of  the  age  as  regards  the  mental  training  of  children 
is  that  of  over-pressure.  We  expect  the  children,  with 
their  brains  still  in  a  formative  state,  to  do  far  more 
mental  work  than  most  of  their  elders  do.  The  danger 
of  over-study  is  particularly  true  in  the  case  of  girls,  who 
are  more  disposed  than  boys  toward  a  quiet,  sedentary 
life;  but  both  sexes  must  be  most  carefully  guarded 
against  too  much  brain-work.  Eyes  are  often  irreparably 
injured  by  school  studies,  not  only  as  the  result  of  in- 
sufficient or  badly-placed  light,  but  in  consequence 
simply  of  too  constant  use.  Many  cases  of  nearsighted- 
ness are  the  result  of  the  improper  use  of  the  eyes  early 
in  life,  or  of  eyes  which  need  correcting  by  glasses. 
Spinal  curvature  and  the  development  of  a  habit  of  stoop- 
ing often  result  from  faulty  methods  of  sitting  at  school 
(see  p.  235). 

It  is  very  important  in  the  "one-session"  school  that 
there  be  a  recess  of  sufficient  length  to  allow  the  child  to 
obtain  something  more  to  eat  than  doughnuts  and  sweets. 
Indeed,  attendance  upon  the  best  school  in  the  world  is 


196  THE    CARE    OF  THE  BABY. 

not  worth  a  hastily-swallowed  breakfast  and  a  hurried, 
indigestible  lunch.  In  this  respect,  as  in  all  others, 
schooling  must  always  be  secondary  to  the  care  of  the 
health.  The  value  of  the  use  of  gymnastic  exercises  has 
already  been  referred  to  earlier  in  this  chapter.  Where 
it  is  possible  to  do  so  a  school  should  be  selected  which 
provides  these  for  the  children,  since  they  not  only  prac- 
tise the  muscles,  but  also  make  an  excellent  break  in  the 
tedium  of  the  school-day  and  return  the  children  re- 
freshed to  their  studies. 

The  subject  of  the  sending  of  older  children  to  board- 
ing-school is  too  many-sided  for  consideration  here.  Over 
against  the  advantage  of  the  increased  independence  and 
self-reliance  attained  must  be  set  the  lack  of  parental  and 
home  influences  and  the  danger  of  acquiring  bad  habits 
of  all  sorts.  From  a  strictly  medical  standpoint  we  have 
chiefly  to  assure  ourselves,  in  selecting  a  boarding-school, 
that  the  children  do  not  pass  either  sleeping  or  waking 
hours  in  crowded  and  ill-ventilated  rooms,  that  they  are 
well  fed,  and  that  they  receive  abundant  opportunity  for 
exercise  and  sleep. 

The  danger  of  contracting  contagious  diseases  in  either 
day-schools  or  boarding-schools  must  never  be  forgotten. 
Unfortunately,  it  is  one  from  which  there  is  no  absolute 
safeguard,  especially  since  many  parents  are  utterly  reck- 
less of  the  risk  to  other  children  which  arises  from  send- 
ing back  too  soon  their  own  children  who  have  been 
ill.  The  periods  of  quarantine  for  the  different  diseases, 
which  will  be  found  in  Chapter  XI.,  should  invariably 
be  followed.  Any  boarding-school  in  which  there  is  an 
extended  outbreak  of  diphtheria,  scarlet  fever,  or  other 
dangerous  infectious  disease  ought  to  be  closed  unless 
there  are  exceptional  facilities  for  isolation  and  treat- 
ment. 


THE   BABY'S  NURSES.  1 97 

Any  other  matters  connected  with  school-life  can  better 
be  treated  of  when  we  consider  the  School-room  in  a  later 
chapter. 


CHAPTER   IX. 

THE  BABY'S  NURSES. 

During  the  period  of  infancy  and  childhood  we  may 
have  to  do  with  four  sorts  of  nurses  :  (i)  the  monthly 
nurse  ;  (2)  the  wet-nurse  ;  (3)  the  child's  nurse  or  nurse- 
maid ;  and  (4)  the  trained  nurse  in  case  of  sickness.  We 
must  briefly  consider  these,  and  the  qualities  to  be  desired 
in  each. 

I.  The  Monthly  Nurse. 

Although  the  monthly  nurse  is  really  the  nurse  for  the 
mother,  yet  it  is  upon  her  that  the  care  of  the  baby 
depends  during  the  earliest  period  of  its  life.  She  it  is 
who  washes  and  dresses  the  child  during  the  time  the 
mother  is  confined  to  bed,  and  who  watches  its  condition 
and  reports  this  to  the  attending  physician. 

The  choice  of  the  monthly  nurse  is  a  matter  of  the 
greatest  importance  for  both  the  mother  and  the  baby. 
The  physician  in  charge  of  the  confinement  may  wish  to 
recommend  some  one  on  whom  he  can  depend,  and  in 
this  case  the  entire  responsibility  rests  upon  him.  If, 
however,  the  selection  is  left  to  the  mother,  she  should 
choose  one  not  so  much  because  she  knows  her  name  as 
the  nurse  of  Mrs.  So-and-so  as  because  she  has,  if  possi- 
ble, some  knowledge  of  her  real  ability.  Many  monthly 
nurses,  and  particularly  the  older  ones  or  those  who  have 
not  had  careful  school-training — and  sometimes,  un- 
fortunately, even    those   who   have   and  who  might   be 


198  THE   CARE    OF   THE  BABY. 

expected  to  know  better — are  filled  with  all  sorts  of 
wrong  ideas  about  the  care  of  the  new-born  child.  Not 
only  so,  but  they  consider  their  "experience"  so  great 
that  they  become  obstinate  and  self-willed,  and  incapable 
of  receiving  advice  or  even  of  obeying  orders.  They  will 
follow  their  own  plans  with  the  baby,  on  the  ground  that 
its  care  is  their  business,  and  not  the  doctor's.  Every 
physician  has  seen  instances  of  great  damage  done  in  this 
way.  A  truly  well-trained  nurse  has  not  only  been 
taught  the  proper  care  of  the  mother  and  infant,  but  has 
learned  also  that  she  is  to  modify  her  methods  promptly 
and  silently  according  to  the  directions  of  the  physician 
in  charge.  Not  only  is  ability  required,  but  adaptability 
and  tact  as  well.  The  nurse  must  know  how  to  get  on 
well  with  the  domestics  and  with  the  relatives  of  the 
patient,  and  how  to  put  up  with  inconveniences  if  the 
house  is  small  and  the  family  in  moderate  circumstances. 
In  a  nurse  who  combines  these  various  requirements  the 
mother  may  put  the  greatest  confidence. 

The  nurse  should  be  engaged  some  months  in  advance, 
and  all  pecuniary  arrangements  made  in  detail.  It  is  a 
good  plan  to  have  her  in  the  house  a  week  or  so  before 
the  confinement  is  expected,  or,  if  this  is  not  possible, 
then  within  easy  reach,  so  that  she  may  be  sent  for  with 
the  very  first  signs  of  beginning  labor.  She  ordinarily 
stays  for  a  month  or  more  after  the  birth  of  the  child,  but 
so  long  a  time  is  not  always  necessary. 

It  is  the  custom  for  the  nurse  to  sleep  in  the  room  of 
the  mother,  or,  still  better,  in  the  adjoining  room.  In 
the  latter,  too,  she  can  take  her  meals  if  it  is  desirable.  She 
is  to  take  full  charge  of  the  baby,  determining  the  hours 
for  feeding,  and  preparing  its  food  should  the  mother 
be  unable  to  nurse  it  herself  She  is  not  ordinarily  ex- 
pected to  do  any  washing  of  the  baby's  clothes,  except, 


THE  BABY'S  NURSES.  1 99 

perhaps,  the  diapers,  nor  to  wash  her  own  garments.  She 
should  be  able  to  prepare  special  articles  of  sick-diet  for 
the  mother,  in  case  there  is  need  for  her  to  do  so. 

2.  The  Wet-nurse. 

The  second  variety  of  nurse  with  which  we  sometimes 
have  to  do  is  the  wet-nurse.  The  advantages  and  disad- 
vantages connected  with  the  employment  of  a  nurse  of 
this  kind  have  already  been  spoken  of  when  considering 
the  Feeding  of  the  Baby  in  Chapter  VI.  When  it  is 
found  desirable  to  nourish  a  baby  in  this  way  the  choice 
of  the  wet-nurse  is  a  matter  of  great  importance.  For- 
tunately, this  also  can  often  be  left  entirely  to  the  phy- 
sician in  charge.  It  is  absolutely  necessary  that  the 
wet-nurse  be  in  good  health,  strong,  and  not  too  fat. 
A  most  careful  examination  on  the  part  of  the  physician 
is  required,  since  nearly  any  form  of  ill-health  impairs 
the  quality  of  the  milk,  and  there  are  some  diseases, 
such  as  syphilis,  which  can  be  transmitted  directly  from 
the  nurse  to  the  child  at  the  breast.  An  examination  of 
the  nurse's  baby  is  also  a  guide  to  the  health  of  its 
mother  and  to  the  nutrient  value  of  her  milk. 

The  nurse  should  preferably  be  from  twenty  to  thirty 
years  of  age.  It  is  better  that  her  own  and  her  foster 
baby  be  of  approximately  the  same  age.  It  is  well  if  her 
own  child  is  several  weeks  old,  in  order  that  a  tendency 
to  the  early  drying  up  of  the  milk  need  not  be  feared, 
and  that  the  milk  itself  may  have  attained  a  stable  char- 
acter. Her  breasts  should  be  firm  and  conical  in  shape 
if  it  is  her  first  child,  or  only  very  slightly  pendulous  if 
she  has  had  several  children.  They  should  contain 
plenty  of  milk,  as  shown  by  the  ability  to  press  some 
from  them  after  the  child  has  done  nursing.  They  should, 
however,  become  distinctly  more  flabby  when  emptied. 


200  THE    CARE    OE  THE   BABY. 

If  they  do  not,  their  size  may  depend  simply  upon  their 
being  covered  by  a  large  amount  of  fat.  The  nipple 
should  project  well  and  be  free  from  cracks. 

She  should  not  be  permitted  to  suckle  her  own  child 
and  her  foster  infant  also.  Few  women  have  enouo-h 
milk  for  both,  and  the  temptation  is  great  to  give  the 
preference  to  her  own  child. 

The  moral  character  of  the  wet-nurse  cannot  be  disre- 
garded. She  should  be  amiable,  temperate,  and  with  a 
lively  sense  of  the  responsibility  of  her  position.  If 
otherwise,  the  health  of  the  child  is  sure  to  suffer.  If 
she  gives  way  to  violent  anger,  her  milk  may  become  for 
the  time  actually  poisonous,  and  produce  colic,  diarrhoea, 
convulsions,  or  even  more  serious  results.  If  intemper- 
ate, she  may  while  intoxicated  allow  the  child  to  suffer 
injury;  and  if  she  is  irresponsible  in  any  other  way,  she 
may  surreptitiously  feed  the  child  with  cow's  milk  if  her 
own  diminishes,  give  it  an  opiate  if  it  does  not  sleep, 
neglect  the  care  of  its  body  in  some  manner,  or  abandon 
it  without  warning. 

A  married  woman  is  to  be  preferred,  but  the  difficulties 
connected  with  obtaining  a  good  wet-nurse  are  so  great, 
and  married  wet-nurses  often  so  scarce,  that  it  is  folly  to 
refuse  to  engage  an  unmarried  one  if  she  is  qualified  in 
other  respects.  Because  she  has  made  one  so  false  a  step 
does  not  prove  her  wholly  bad.  We  must  remember  that 
we  are  not  seeking  examples  of  morality  or  instituting 
rewards  for  virtue  or  punishments  for  crime,  but  are 
simply  trying  to  obtain  a  suitable  manufacturer  of  human 
milk  for  a  child  who  will  suffer  without  it.  This  remark 
applies,  however,  only  as  regards  the  first  illegitimate 
child.  A  woman  who  has  had  more  than  one  child  ille- 
gitimately will  probably  be  depraved  in  other  respects 
and  be  unfit  to  be  trusted.     It  is  only  through  the  danger 


THE   BABY'S  NURSES.  20I 

of  neglect,  however,  that  the  moral  vices  of  a  wet-nurse 
affect  her  foster  child.  There  is  no  more  probability  of 
a  baby  imbibing  the  character  of  the  nurse  through  the 
milk  which  she  gives,  much  as  we  hear  this  talked  about, 
than  there  is  danger  of  a  child  learning  to  "moo" 
because  it  is  fed  on  cow's  milk. 

It  is  necessary  to  regulate  carefully  the  wet-nurse's 
diet  and  her  method  of  living  in  general,  according  to 
the  principles  which  have  been  determined  in  a  previous 
chapter  to  be  of  service  to  the  health  of  the  nursing 
mother  (pp.  120-124).  The  nurse  must  have  plenty  of 
exercise  in  the  open  air,  sleep  in  a  well-ventilated  room, 
and  be  provided  with  an  abundance  of  digestible,  nutri- 
tious food.  At  the  same  time  we  must  remember  that  a 
woman  taken  from  the  lower  walks  of  life  and  given  un- 
restrained opportunity  to  indulge  freely  in  food  to  which 
she  has  not  been  accustomed  is  very  apt  to  eat  too  much 
and  to  exercise  too  little.  Indigestion  follows  as  a 
natural  result,  and  the  health  of  the  nurse  suffers  and 
her  milk  diminishes  or  even  disappears.  The  use  of 
stimulants  by  the  wet-nurse  is  seldom  necessary.  A 
woman  whose  health  demands  them  is  not  in  a  fit  con- 
dition to  fill  the  place. 

Finally,  the  wet-nurse  must  be  made  to  adhere  to  the 
rules  for  nursing  laid  down  in  a  previous  chapter  (Chap- 
ter VI.).  But  however  well  qualified  the  nurse  may  seem, 
a  wise  mother  will  not  hand  over  the  care  of  the  baby 
entirely  to  her,  but  will  exercise  a  careful  supervision 
over  everything  that  goes  on,  particularly  at  night. 

3,  The  Nurse-maid, 

The  third  form  of  nurse,  and  the  one  whose  qualifica- 
tions deserve  especial  attention,  is  the  ordinary  child's 
nurse.      Scarcely   anything   is   more   difficult    than    the 


202  THE    CARE    OF   THE   BABY. 

obtaining  of  a  thoroughly  good  child's  nurse,  scarcely 
anything  more  important  to  the  child,  and  yet  scarcely 
anything  more  carelessly  done.  Many  a  mother  en- 
gages a  woman  of  whom  she  knows  practically  nothing, 
and  transfers  to  her,  blindly  and  completely,  the  care  of 
the  baby.  To  say  that  this  is  all  wrong  is  easy;  to  ob- 
viate it  is  difficult. 

Mothers  often  state  with  great  reason  that  one  can- 
not expect  all  the  virtues  for  a  few  dollars  a  week,  and 
with  this  fatalistic  salve  to  their  consciences  they  let  the 
matter  rest ;  but  the  ill  results  of  this  indifference  are 
not,  however,  so  easily  escaped,  and  will  sooner  or  later 
show  themselves  in  some  way. 

A  mother  should  first  consider  carefully  what  qualities 
are  to  be  desired  in  a  nurse-maid,  and  then  exert  her 
efforts  to  discover  one  who  possesses  them.  Finally, 
after  she  has  obtained  the  "invaluable  girl"  it  is  most 
important  of  all  never  to  trust  her.  Even  could  the 
nurse's  good  intentions  be  relied  upon,  her  knowledge 
and  judgment  are  liable  to  be  deficient,  however  honest 
she  may  be  in  her  efforts  to  do  her  best.  By  this  it  is 
not  meant  that  the  mother  dare  appear  openly  distrustful, 
since  such  a  course  would  discourage  the  best  nurse,  but 
rather  that  she  must,  as  a  matter  of  course,  give  a  con- 
stant supervision,  and  make  it  understood  that  she  her- 
self is  the  chief,  and  not  the  second,  in  the  care  of  the 
baby.  It  is  her  duty  to  her  child  to  be  secretly  a  spy 
upon  the  nurse,  disagreeable  as  the  situation  is. 

The  entire  confidence  which  mothers  often  repose  in 
their  nurse-maids  is  a  matter  of  wonder  to  others,  and 
sometimes  of  indignation.  Instances  are  too  common  in 
which  a  stranger,  moved  to  pity  by  seeing  a  baby  wofully 
neglected  or  abused,  has  with  pure  disinterestedness 
reported  the  case  to  the  mother,  only  to  be  met  with  the 


THE   BABY'S  NURSES.  203 

haughty  answer,  "  I  have  every  confidence  in  my  nurse." 
Nurses  are  constantly  seen  in  parks  and  other  public 
places  absorbed  in  reading,  or  chatting  unconcernedly 
with  each  other  or  with  some  of  their  male  friends,  while 
the  babies  lie  crying  in  their  carriages,  perhaps  exposed 
to  the  full  rays  of  a  hot  sun  or  unprotected  from  a  cold 
wind.  Many  a  time  we  may  see  an  old  woman  support- 
ing a  crying  child  on  her  knee  and  joggling  it  roughly 
up  and  down  to  the  sound  of  some  crooning  ditty  until 
one  would  think  that  its  poor  little  head  must  ache,  and 
its  teeth,  if  it  has  any,  must  be  loose  in  its  jaws.  The 
bad  effects  of  such  treatment  have  already  been  referred 
to  in  the  preceding  chapter.  How  often,  too,  are  babies 
taken  by  nurses  on  their  shopping  expeditions,  or  even 
to  the  houses  of  their  friends,  where  they  are  perhaps  ex- 
posed to  some  dangerous  contagious  disease! 

Seeing,  then,  how  important  the  choosing  of  the  nurse- 
maid is,  we  must  review  some  of  the  qualifications  which 
she  should  possess.  This  applies  not  only  to  her  physical 
qualities  but  to  her  mental  and  moral  characteristics  as 
well,  since  the  child  is  liable  to  have  its  mind  and  dispo- 
sition moulded  largely  by  its  nurse,  and  it  is  mani- 
festly impossible  for  it  to  attain  the  traits  so  much 
to  be  desired  if  its  constant  pattern  is  the  reverse  of 
them  all. 

In  the  first  place,  the  nurse  must  be  in  good  health. 
The  existence  of  any  disease,  and  especially  of  consump- 
tion or  other  form  of  tuberculosis,  should  be  an  absolute 
disqualification.  The  employment  of  a  nurse  with 
syphilis  must  also  be  carefully  guarded  against.  Such 
conditions  as  offensive  nasal  catarrh,  bad  breath,  pro- 
fuse odorous  perspiration,  and  the  like,  although  not 
actually  dangerous  to  the  child,  render  the  presence  of 
the  nurse  very  unpleasant. 


204  THE    CARE    OF   THE   BABY. 

There  is  some  question  regarding  the  best  age  for  a 
nurse  to  be.  In  general  the  age  of  thirty  to  forty-five 
years  is  to  be  preferred.  Half-grown  girls  are  seldom  fit 
to  have  the  charge  of  a  child  entrusted  to  them;  young 
women  are  very  liable  to  give  too  much  attention  to  en- 
joying themselves  with  their  friends;  while  old  women, 
although  sometimes  invaluable,  are  as  a  class  prone  to  be 
self-opinionated  and  forgetful.  Of  course  there  are  nu- 
merous exceptions  to  this  statement. 

The  nurse  should  be  strong.  If  delicately  and  slightly 
built,  the  carrying  of  the  baby  for  hours  at  a  time 
will  be  beyond  her  strength.  If,  on  the  other  hand, 
she  is  very  stout,  she  will  be  able  to  do  little  more  than 
support  her  own  weight  when  walking.  Besides,  the 
mass  of  her  flesh  is  very  heating  to  a  baby  held  in  her 
arms  or  lap  in  hot  weather. 

The  comeliness  of  the  nurse  is  a  matter  of  comparative 
indifference.  Children  are  apt  to  think  that  all  those 
whom  they  love  are  beautiful.  If  only  the  nurse  loves 
her  charge  and  has  features  not  actually  repelling,  more 
is  not  needed.  Even  babies  in  arms  perceive  the  loving 
and  trust-inspiring  expression  and  are  contented. 

This  sincere  love  of  little  children  is  one  of  the  great 
requisites  of  a  good  nurse.  She  should  have  chosen  her 
work,  not  because  it  offered  as  good  a  way  as  any  of 
gaining  a  livelihood,  but  because  she  prefers  it  to  any- 
thing else.  If  the  love  be  present,  other  good  qualities 
will  not  be  entirely  wanting.  A  devoted  nurse  will  not, 
for  instance,  easily  lose  her  patience  or  become  angry 
with  the  child,   even  though  it  is  really  annoying. 

Two  other  qualities  which  are  very  important  are  in- 
telligence and  docility.  The  nurse  should  have  sufficient 
intelligence  to  be  able  to  understand,  remember,  and 
carry  out  any  instructions  given  her,  and  should  be  docile 


THE   BABY'S  NURSES.  205 

enough  to  be  glad  to  do  this,  no  matter  how  much  pre- 
vious experience  she  has  had.  Experience  is,  of  course, 
of  the  greatest  vahie,  yet  experience  without  docility  is 
especially  to  be  shunned.  A  nurse  of  this  character  is 
as  hard  to  mould  as  a  stone,  and  can  be  taught  abso- 
hitely  nothing.  Better  far  an  intelligent  though  inex- 
perienced woman  who  is  willing  to  learn. 

Truthfulness  and  conscientiousness  on  the  part  of  the 
nurse  are  greatly  to  be  desired,  but,  unfortunately,  far 
too  rare.  How  is  it  possible  for  a  child  to  be  taught  by 
its  parents  the  sin  of  lying  and  the  importance  of  obedi- 
ence if  it  constantly  hears  its  nurse  telling  falsehoods 
and  sees  things  done  which  have  been  positively  for- 
bidden ?  Then,  too,  the  baby  may  be  saved  much  suffer- 
ing if  the  nurse  has  the  courage  to  admit  when  she  does 
not  know,  and  to  report  promptly  any  alteration  in  the 
child's  health  or  any  accident  which  may  have  befallen 
it,  even  though  this  may  have  been  the  result  of  her  own 
carelessness. 

A  cheerful  and  lively  disposition  is  very  important, 
particularly  when  the  baby  reaches  the  age  when  talking 
commences.  It  sometimes  happens  that  a  child's  mental 
faculties  develop  very  slowly  if  it  is  much  with  a  nurse 
who  is  very  quiet  and  makes  no  effort  to  teach  it,  but 
that  they  at  once  take  on  a  rapid  growth  when  one  of  a 
different  nature  is  substituted. 

The  possession  by  the  nurse  of  good  manners  and 
gentleness  of  disposition,  and  of  a  control  of  good  lan- 
guage, is  of  great  advantage  when  it  can  be  obtained. 
Children  will  thus  learn  instinctively  to  be  polite  and 
kind.  A  rough,  boisterous,  ill-mannered  child  is  the 
natural  outcome  of  association  with  a  coarse-natured, 
loud-voiced  nurse.  Yet  mothers  often  seem  to  overlook 
this  very  obvious  fact. 


206  THE    CARE    OF   THE   BABY. 

Finally^  the  nurse  must  be  cleanly  in  her  person  and 
dress,  temperate,  methodical,  and  neat.  A  woman  who 
does  not  keep  herself  clean  cannot  be  expected  to  care 
properly  for  the  cleanliness  of  her  charge  or  to  see  that 
the  nursery  is  kept  free  from  dirt.  So,  too,  if  she  has 
not  habits  of  neatness,  method,  and  order  there  will  be  a 
constant  state  of  confusion  in  the  nursery,  nothing  will 
ever  be  in  its  place,  the  baby's  clothing  will  always  be 
out  of  repair,  and,  especially  if  there  are  several  children, 
her  work  will  always  be  behindhand. 

The  difficulty  attending  the  procuring  of  nurses  who 
are  in  any  sense  qualified  for  their  position  and  who  can 
be  at  all  trusted  is  very  great,  inasmuch  as  nurse-maids 
frequently  come  from  the  ignorant  and  untrustworthy 
classes.  To  obviate  this  difficulty  the  plan  of  having  a 
nursery  governess  is  sometimes  followed  with  advan- 
tage, especially  where  there  are  several  children  in  the 
family.  The  occupant  of  such  a  position  should  be  ex- 
perienced in  the  care  of  children,  intelligent,  well-edu- 
cated and  refined,  and  capable  of  teaching  the  rudiments 
of  an  education  to  children  who  have  not  yet  been  sent 
to  school.  In  some  cases  she  may  have  under  her  super- 
vision an  ordinary  nurse-maid,  and  it  should  be  her 
special  duty  to  see  that  the  children  receive  proper  care 
from  the  maid.  Such  a  woman  expects  and  should 
receive  greater  remuneration  than  an  ordinary  nurse- 
maid, and  can  hardly  be  asked  to  take  her  meals  with  the 
domestics.  Her  position  in  the  household  is,  indeed,  an 
anomalous  and  often  inconvenient  one  for  all  concerned. 

The  excellent  plan  of  having  training  schools  for 
nurse-maids  was  devised  some  years  ago,  and  has  been 
put  into  successful  ])ractice  in  several  of  our  cities.  A 
further  carrying  out  of  the  scheme  in  other  places  is 
much  to  be  desired,  for  it  would  help  largely  to  do  away 
with  the  present  very  perplexing  nurse  problem. 


THE   BABY'S  NURSES.  2,OJ 

Having  dealt  with  the  nurse's  qualities,  we  have  still 
to  consider,  first,  the  nurse's  duties  to  the  child,  and, 
second,  the  mother's  duties  to  the  nurse. 

The  nurse  is  generally  expected  to  take  as  complete 
charge  of  the  child  as  the  mother  chooses.  She  washes 
and  dresses  it,  prepares  its  food  if  it  is  on  the  bottle,  and 
takes  it  out  for  its  airing,  either  in  her  arms  or  in  the 
perambulator  as  the  mother  wishes.  She  sleeps  in  the 
room  with  it  and  attends  to  it  at  night,  or,  if  the  baby 
sleeps  in  the  mother's  room,  arises  when  called  and  gives 
it  any  attention  that  may  be  required.  She  reports 
promptly  the  slighest  evidence  of  illness.  As  the  baby 
grows  she  endeavors  to  train  it  mentally  and  morally, 
enforcing  obedience,  politeness,  neatness,  and  the  like, 
on  the  lines  already  indicated.  Possibly  the  repairing 
of  the  child's  garments  is  assigned  to  her. 

There  are  certain  things  which  the  nurse  should  be 
distinctly  instructed  that  she  shall  not  do,  and  some  of 
these  "dont's"  the  mother  may  profitably  take  to  her- 
self as  well.  She  should  never  be  impatient  or  cross 
with  the  little  one.  She  should  never  omit  to  say 
"please"  and  "thank  you"  if  she  asks  a  favor  of  the 
child,  else  the  use  of  the  words  on  its  part  cannot  be 
expected.  She  should  never  use  harsh  commands  or 
rough  language  of  any  kind.  She  should  endeavor  to 
exact  implicit  obedience  on  the  part  of  the  child,  but  she 
should  also  never  show  anger  or  take  the  punishment 
into  her  own  hands,  except  such  harmless,  not  corporal 
forms  as  the  mother  distinctly  permits — for  example,  the 
taking  away  of  a  doll,  the  making  to  sit  in  a  corner,  etc., 
but  never  the  shutting  in  a  dark  closet.  She  must  never 
give  any  object  to  a  child  old  enough  to  talk  simply 
because  it  cries  for  it,  but  must  insist  upon  being  asked 
politely  for  it.     She  should  teach  a  child  to  have  no  fear 


208  THE    CARE    OF   THE   BABY. 

of  harmless  objects  by  herself  never  showing  fear.  She 
should  never  allow  the  child  to  see  terrifying  sights  or 
frighten  it  in  the  slightest  degree.  A  nurse  who  tells  a 
child  a  ghost-story  or  who  makes  it  fear  the  dark  is  little 
short  of  a  criminal,  and  deserves  to  be  punished  as  such. 

On  behalf  of  all  physicians,  since  their  labors  with 
children  are  not  easy  at  the  best,  I  do  strongly  urge  that 
neither  mother  nor  nurse  ever  hold  up  the  doctor  as  a 
bogy  who  will  give  some  bad  medicine  or  take  the  child 
away  if  it  does  not  obey  some  command  which  has  been 
given.  Such  a  course  destroys  the  child's  trust  in  and 
fondness  for  the  physician,  and  renders  his  examination 
and  treatment  of  it  when  sick  far  more  difficult. 

The  nurse  should  never  administer  a  particle  of  medi- 
cine unless  told  to  do  so  by  the  mother,  never  under  any 
circumstances  give  any  article  of  food  or  drink  to  which 
the  child  is  unaccustomed,  never  give  food  solely  for  the 
purpose  of  quieting  a  child  if  crying,  and  never  allow  it 
to  drink  out  of  a  public  glass  or  cup.  She  should  never 
start  the  flow  of  milk  from  a  nursing-bottle  by  sucking 
at  the  nipple,  and  never  cool  the  food  of  an  older  child 
by  blowing  on  it.  She  should  never  use  baby-talk  to  a 
child  learning  to  talk,  as  this  retards  its  acquiring  of 
distinct  speech. 

Finally,  she  must  never  allow  the  baby  to  lie  or  sit  in 
the  hot  sun  or  in  a  windy  or  damp  place,  and  she  should 
not  take  it  into  a  shop  or  a  private  house  without  the 
mother's  consent. 

What,  now,  are  the  mother's  duties  to  the  nurse? 

Chief  of  all  is  that  of  paying  her  well  if  she  is  worth 
it — and  she  should  not  be  employed  if  she  is  not.  The 
baby  is  far  too  precious  to  allow  of  hesitation  in  this  mat- 
ter. The  mother  should  avoid  imposing  work  upon  her 
which  does  not  belong  to  her,  for  if  she  is  a  faithful  nurse 


THE   BABY'S  NURSES.  209 

she  will  have  enough  to  do  to  attend  to  her  own  duties. 
She  should  see  that  the  nurse  has  full  opportunities  to  do 
her  shopping  and  to  visit  her  friends  unattended  by  the 
baby,  since  this  removes  the  temptation  of  taking  it  with 
her.  While  openly  assuming  the  entire  guidance  of  the 
baby's  life,  and  secretly  watching  that  her  directions  are 
properly  carried  out,  the  mother  must  show  no  sign  of 
distrust,  and  must  endeavor  to  enlist  the  interest  and 
win  the  affection  of  the  nurse. 

Finally,  she  must  act  with  the  nurse,  and  not  against 
her,  in  the  management  of  the  children,  always  upholding 
the  nurse's  authority  before  them,  even  though  she  after- 
ward explain  to  her  in  private  that  she  differs  with  her, 
and  wishes  in  the  future  that  some  other  line  of  action 
be  pursued. 

A  word  with  regard  to  French  and  German  nurses. 
If  it  is  a  difficult  matter  to  find  a  thoroughly  good  nurse 
among  the  large  number  of  English-speaking  nurses, 
how  much  more  among  the  much  smaller  number  of 
French  and  German  ones  who  present  themselves!  If  a 
mother  desires  to  employ  one  of  foreign  race,  she  should 
first  of  all  see  that  she  has  the  qualities  of  a  child's  nurse. 
That  the  child  learn  a  foreign  language  is  far  less  im- 
portant than  that  it  be  well  cared  for  in  body  and  mind. 
Moreover,  there  is  a  very  strong  temptation,  hard  to 
resist,  to  insist  upon  the  child  spending  almost  all  its 
time  with  the  nurse,  in  order  that  it  may  have  the 
greatest  opportunity  to  acquire  her  language.  No 
mother  who  loves  her  little  one  can  afford  to  run  the  risk 
which  this  entails. 

4.  The  Trained  Nurse. 
The  nurse  trained  especially  for  the  care  of  the  sick  is 
the  last  one  of  the  baby's  caretakers  to  whom  we  must 

14 


2IO  THE    CARE    OF   THE   BABY. 

turn  our  attention.  In  cases  of  slight  illness,  or  even  in 
more  serious  disease,  the  mother  with  the  help  of  the 
nurse-maid  ma}'  be  able  to  carry  out  the  directions  of  the 
physician  without  outside  help.  Often,  however,  this  is 
almost  impracticable.  A  sick  child  demands  the  constant 
attention  of  some  one,  and  it  is  frequently  an  utter  im- 
possibility for  a  mother  to  attend  properly  to  the  patient 
and  to  look  after  her  other  duties.  Moreover,  of  all 
things  experience  is  to  be  desired  in  the  care  of  sick- 
ness, and  a  young  mother  has  usually  had  no  chance  to 
acquire  it. 

Fortunately,  in  many  of  the  larger  cities  a  skilful 
trained  nurse  can  now  be  readily  obtained.  Such  a  nurse 
is  more  than  a  luxury.  She  brings  with  her  the  great- 
est comfort  to  the  inexperienced  mother  and  increased 
chances  of  recovery  to  the  child.  Unless  the  expense 
absolutely  forbids,  every  child  who  is  or  who  is  likely  to 
become  seriously  ill  should  promptly  be  provided  with  a 
trained  nurse.  A  good  nurse  is  just  as  important  as  a 
good  doctor — yes,  even  more  so,  for  the  skill  of  a  doctor 
cannot  avail  unless  his  directions  are  carefully  carried 
out.  The  mother's  anxiety  and  her  disposition  to  yield 
to  the  child's  wishes  greatly  interfere  with  her  judgment 
and  her  ability. to  nurse  properly.  It  is  often  astonishing 
how  a  child,  generally  rebellious  to  parental  control,  will 
yield  readily  to  the  desires  of  the  trained  nurse,  if  only 
her  management  be  not  interfered  with.  The  nurse,  as 
a  stranger,  awakens  a  certain  degree  of  respect  which 
the  illy-trained  child  has  often  unfortunately  ceased  to 
have  for  its  parents. 

The  employment  of  a  nurse,  however,  does  not  mean 
that  all  authority  is  to  be  taken  from  the  mother.  The 
child  is  hers  ;  her  duty  to  it  remains  the  same,  and  she  is 
still  mistress  in  the  house.     The  nurse  is  her  employee, 


THE   BABY'S  NURSES.  211 

and  will  obey  her  directions  if  she  gives  them.  At  the 
same  time,  the  nurse  is  directly  answerable  to  the  phy- 
sician, and  dare  not,  if  she  is  faithful,  disobey  his  orders. 
As  she  has  been  engaged  to  assume  the  responsibility  of 
the  nursing-  and  to  exercise  her  trained  skill  in  the  care 
of  the  child,  the  mother  will  be  chary  of  interfering, 
unless  she  sees  to  a  certainty  that  things  are  not  going 
well  and  that  the  nurse  is  not  as  competent  as  she  ought 
to  be;  and  even  then  she  had  better  talk  the  matter  over 
with  the  physician  first.  Unfortunately,  not  all  trained 
nurses  are  really  helpful.  Some  are  lazy,  or  indifi'erent, 
or  untrustworthy.  Some  are  so  busy  maintaining  their 
own  dignity  that  they  are  a  burden  to  the  household  and 
a  hindrance  rather  than  a  help.  This  does  not,  however, 
mitigate  against  the  value  of  trained  nurses  as  a  class.  A 
really  good  one — and  there  are  many — is  a  help  indeed. 

The  special  qualifications  of  a  trained  nurse  are  beyond 
the  province  of  this  volume,  and  can  be  referred  to  but 
briefly.  The  nurse  should  have  been  thoroughly  taught 
in  a  training  school  connected  with  a  good  hospital, 
and  she  should  have  had  special  experience  in  the  nurs- 
ing of  sick  children.  Many  a  nurse  is  excellent  with 
adults,  but  does  not  possess  the  peculiar  knack  of  caring 
for  a  sick  child.  An  old  woman  who  has  merely  gathered 
together  a  lot  of  useless  or  harmful  theories  and  practices 
may  have  had  a  deal  of  "  experience,"  but  it  may  only 
have  confirmed  her  in  her  fatal  mistakes.  Such  a  woman 
is  to  be  avoided  carefully.  She  is  no  more  a  trained 
nurse  than  an  "herb  doctor"  is  a  physician.  This  by 
no  means  implies  that  all  elderly  women  without  hospital 
training  are  worthless,  for  many  of  them  are  excellent. 
Still,  a  hospital  nurse  is  usually  to  be  preferred. 

A  trained  nurse  should  be  young  and  strong,  docile,  alert, 
self-possessed,  and  gentle  of  hand,  step,  and  voice.     She 


'21.2  THE    CARE    OF   THE   BABY. 

should  be  neat  in  appearance  and  very  clean.  She  should 
also  be  able  to  adapt  herself  readily  to  the  disposition  of 
the  patient  and  to  the  various  conditions  existing  in  the 
household.  She  should  wear  wash-dresses,  slippers, 
and  a  nurse's  cap,  all  of  which  are  not  intended 
as  a  mark  of  her  office  only,  but  have  their  dis- 
tinct purposes  of  cleanliness  and  quiet  as  well.  Her 
experience  should  have  taught  her  to  observe  carefully 
the  different  evidences  of  disease,  which  we  shall 
study  in  a  later  chapter,  and  to  understand  to  a  consider- 
able extent  what  they  indicate.  If  she  has  been  well 
trained  and  is  capable,  she  will  at  once  take  charge  of 
the  ordering  of  the  sick-room  and  the  diet  of  the  patient, 
and  will  inspire  a  feeling  of  relief  in  the  mind  of  the 
anxious  mother — and  of  the  doctor,  too — such  as  no  words 
can  express.  She  will  see  that  the  child's  food  is  pre- 
pared properly,  and  it  is  her  duty  even  to  go  into  the 
kitchen  and  to  prepare  it  herself  if  it  cannot  be  managed 
otherwise.  Of  course  this  cannot  be  done  in  cases  of 
contagious  disease,  since  she  must  then  not  go  through 
the  house  to  any  extent.  In  diseases  of  this  nature  the 
nurse  cannot  associate  with  others  of  the  household.  She 
must  sleep  and  eat  in  the  sick-room  or  in  an  adjoining 
room  connected  with  it,  and  she  should  pass  through  the 
house  only  on  her  way  out  for  her  daily  walk,  stopping 
to  talk  with  no  one  and  entering  no  other  room.  In 
preparing  to  go  out  she  should  wash  her  hands  thoroughly 
with  carbolized  water  (Appendix,  97)  and  change  her 
slippers  for  walking-shoes  and  her  wash-dress  for  her 
street-gown.  After  the  disease  is  over  she  will  take  the 
proper  steps  for  disinfecting  the  room.  These  will  be 
described  in  Chapter  X. 

If  a  mother  is  herself  nursing  a  child  with  an  infectious 
disease,    she  must  separate  herself  absolutely  from  her 


THE   BABY'S  ROOMS.  213 

other  children,  and  follow  in  all  respects  the  niles  given 
for  the  condnct  of  the  trained  nnrse. 

Further  remarks  on  the  duties  of  the  trained  nurse  will 
be  found  in  the  chapter  on  the  Management  of  Sick 
Children  (p.  248). 

As  with  the  nurse-maid,  there  is  a  duty  of  the  mother 
to  the  trained  nurse.  The  nurse  is  not  made  of  iron,  as 
seems  often  supposed,  and  if  she  is  to  accomplish  the 
best  results  for  the  child  she  must  have  regular  times  for 
sleep  and  outdoor  exercise.  Worn  out  by  watching,  she 
may  easily  overlook  her  duties,  administer  the  wrong 
medicine,  or  make  some  other  serious  blunder.  In  their 
interest  in  their  patients  nurses  frequently  forget  this  fact. 
The  mother  must  see  that  the  nurse  takes  sufficient  sleep 
and  fresh  air,  that  she  is  well  fed,  and  that  her  garments 
are  laundered  for  her. 

In  very  severe  and  prolonged  cases  two  nurses  are 
needed,  or  the  mother  must  arrange  that  she  or  some  one 
else  take  turns  with  the  nurse. 


CHAPTER   X. 

THE   BABY'S   ROOMS. 

However  much  we  may  desire  to  select  rooms  for  the 
baby  according  to  some  definite  fixed  rule,  such  an 
arrangement  is  manifestly  impossible  unless  we  build  a 
house  to  suit  the  baby,  and  then  occupy  it  uninterrupt- 
edly. Frequently  not  what  is  best,  but  what  is  possible, 
is  the  plan  which  must  be  adopted.  This  applies  par- 
ticularly to  those  occupying  hotels  or  boarding-houses, 
but  even  also  to  householders  to  a  considerable  degree. 
The  advice  given  in  this  chapter  is  intended  to  be  fol- 
lowed as  closely  as  circumstances  will  permit. 


214  ^^^   CARE   OF  THE  BABY. 

The  baby's  first  room  is,  of  course,  that  of  the  mother. 
Here  it  was  born,  and  here  it  will  probably  remain  until 
it  is  several  weeks  old  at  least.  Later,  two  rooms  should 
be  provided  for  its  occupancy — the  one  for  its  waking 
hours,  and  the  other  to  sleep  in  at  night  and  when  taking 
its  morning  and  afternoon  naps.  These  rooms  must  be 
selected  with  the  greatest  care,  as  they  are  the  most  im- 
portant in  the  house.  As  the  child  grows  older  the  selec- 
tion of  other  rooms  is  to  be  considered — namely,  the  sick- 
room and  the  school-room.  The  principles  which  govern 
the  choice  of  any  of  these  rooms  apply  equally  well  in 
cases  in  which  necessity  compels  the  children  to  share 
their  apartments  with  other  members  of  the  family. 

I.  The  Day  Nursery. 
The  position  of  the  day  nursery  is  a  matter  of  much 
moment.  As  the  family  can  rarely  undertake  to  provide 
one  nursery  for  summer  and  another  for  winter,  the  selec- 
tion of  the  room  must  be  made  with  reference  to  its 
suitability  in  winter-time,  since  in  warm  weather  the 
child  will  be  nearly  the  entire  day  out  of  doors,  or  very 
possibly  with  the  family  at  a  summer  resort.  It  is  neces- 
sary, therefore,  to  choose  for  the  day  nursery  the  brightest, 
airiest  room  in  the  house.  Sunlight  in  the  room  is  of 
inestimable  value,  remembering,  however,  that  the  new- 
born baby  cannot  stand  a  bright  light  without  injury  to 
its  eyes,  and  that  at  this  period  it  must  be  properly  pro- 
tected. The  exposure  should  preferably  be  south.  If 
this  cannot  be  had,  a  room  with  a  window  look- 
ing east  is  rather  better  than  a  westward  outlook,  on 
account  of  the  presence  of  the  morning  sun.  A  corner 
room  with  large  windows  opening  south  and  west  is  the 
ideal  one.  Indeed,  there  should  always  be  more  than 
one  window  if  it  can  be  had.     In  the  warm  season  the 


THE   BABY'S  ROOMS.  21  5 

heat  of  the  sun  can  be  modified  by  the  use  of  blinds  or 
awnings.  There  may  be  difficulties  connected  with  the 
heating,  or  some  other  conditions  which  render  a  certain 
room  undesirable,  although  the  exposure  is  all  that  can 
be  wished.  Naturally  all  the  various  circumstances  must 
be  taken  into  consideration. 

The  nursery  should  not  be  upon  a  level  with  the 
ground,  as  it  is  apt  to  be  too  damp.  The  third  story  is 
the  best,  provided  it  is  not  directly  under  the  roof.  More 
light,  air,  and  dryness  can  usually  be  obtained  at  this 
elevation,  while  the  noise  in  the  house  is  less  liable  to 
disturb  the  nursery,  or  that  in  the  nursery  to  annoy  the 
rest  of  the  house.  The  room  should  have  as  much  air- 
space as  possible.  There  ought  to  be  from  500  to  1000 
cubic  feet  for  each  individual  occupying  it.  The  num- 
ber of  cubic  feet  is  easily  calculated  by  multiplying  the 
length  of  the  room  by  its  breadth,  and  the  result  by  the 
height.  Estimating  1000  feet  as  the  supply  required  for 
each  person,  a  room  10  feet  high,  15  feet  wide,  and  20 
feet  long  would  accommodate  two  children  and  the 
nurse.  This  does  not,  of  course,  mean  to  the  exclusion 
of  proper  ventilation,  and  as  the  number  of  inmates  is 
often  greater  than  this,  and  the  room  no  larger,  or  even 
smaller,  ventilation  must  be  still  more  carefully  at- 
tended to. 

The  ventilation  and  heating  of  the  room  is  often  a 
difficult  problem.  Proper  ventilation  consists  in  provid- 
ing a  constant  and  abundant  supply  of  fresh  air,  yet 
without  draughts.  A  house  built  to  accomplish  success- 
fully both  heating  and  ventilating  will  supply  fresh  warm 
air  and  will  remove  through  ventilators  the  air  already 
used  without  the  necessity  of  opening  a  window.  Few 
houses,  however,  are  constructed  in  this  way.  In  a  dwell- 
ing as  ordinarily  built,  without  this  system,  an  open  fire- 


2l6 


THE    CARE    OF  THE   BABY. 


place  will  furnish  a  method  of  removing  air  that  is  unex- 
celled, except  that  it  is  prone  to  create  draughts  upon  the 
floor,  which  must  be  particularly  guarded  against. 

Where  there  is  no  fire-place  a  ventilator  connected 
with  a  chimney  may  be  put  in  the  upper  part  of  the  wall 
and  the  foul  air  removed  in  this  way.  Furnace  heating 
through  flues  and  a  register  supplies  fresh  warmed  air 
from  without.  If  fresh  air  must  be  admitted  from  a 
window,  it  is  very  important  to  have  it  done  in  a  way  to 
avoid  draughts.  This  may  be  accomplished  by  the  use 
of  an  ordinary  ventilating-board,  which  consists  of  a 
board  4  to  6  inches  high,  made  to  fit  accurately  below 
the  lower  sash,  which  is  closed  upon  it.     In  this  way  air 


Fig.  57. — Window  ventilator:  view  from  inside  the  room. 

is  admitted  between  the  upper  and  lower  sashes.  In 
place  of  fitting  under  the  lower  sash  the  board  may  be 
10  or  12  inches  high  and  may  be  placed  against  the 
inside  of  the  window-frame.  If  the  lower  sash  is  now 
raised  2  or  3  inches,  air  enters  below  and  is  directed 
upward  between  the  sash  and  the  board,  at  the  same 
time  that  it  also  enters  the  room  between  the  sashes,  thus 
producing  two  currents.  An  improvement  upon  this 
arrangement  is  the  apparatus  shown  in  the  illustration 
(Fig.  57).  The  pipes,  of  which  the  bent  portion  is  upon 
the  inside  of  the  room,  serve  to  direct  the  cold  air  upward 
and  thus  to  prevent  draughts.     By  a  damper  in  each  the 


THE   BABY'S  ROOMS.  21/ 

amount  of  air  entering  can  be  regulated  at  pleasure. 
The  board  itself  is  of  two  pieces  which  slide  upon  each 
other,  thus  allowing  the  apparatus  to  be  fitted  under  the 
sash  in  a  window  of  any  breadth.  This  ventilator  can 
be  obtained  of  any  large  hardware  or  house-furnishing 
store.  Another  apparatus  sometimes  used  is  the  revolv- 
ing-wheel ventilator,  which  may  be  set  in  one  of  the 
upper  window-panes,  and  is  made  to  rotate  by  the  pas- 
sage of  the  air  through  it.  A  wooden  frame  covered 
with  cheese-cloth  or  thin  muslin,  and  made  to  fit  in  the 
window  like  a  fly  screen,  admits  air  freely  but  checks 
draughts,  and  is  sometimes  useful. 

Besides  this  constant  ventilation  the  room  must  be 
aired  thoroughly  with  wide-open  windows  once  or  twice 
a  day,  at  a  time  when  the  child  is  absent,  and  then  be 
well  warmed  before  it  is  used  again. 

For  heating  the  nursery  probably  nothing  as  yet  takes 
the  place  of  a  good  hot-air  furnace,  since  this  is  both 
easily  controlled  by  opening  or  closing  the  register,  is 
more  efficient  in  cold  weather,  and  aids  ventilation  by 
supplying  fresh  warm  air  from  without.  The  air,  it  is 
true,  is  often  too  dry,  particularly  when  the  ordinary 
furnace  supplied  with  drums  and  hot-air  chamber  is 
used.  It  is  also  liable  at  times  to  carry  coal-gas  with  it. 
Air  coming  in  flues  from  over  hot- water  pipes  is  prob- 
ably preferable.  The  dryness  may  be  modified  to  a  cer- 
tain extent  by  placing  vessels  containing  water  imme- 
diately in  front  of  the  register.  An  apparatus  for  this 
purpose,  consisting  of  a  perforated  metal  case  containing 
a  porous  pottery  vessel  of  water,  and  made  to  hang  in 
front  of  a  wall  register,  has  been  placed  on  the  market. 

It  is  a  good  plan  to  have  the  registers  rather  high  in 
the  wall,  as  this  puts  them  where  they  cannot  be  touched 
by  the  children,  and  tends  also  to  prevent  draughts. 


2l8  THE    CARE    OF  THE   BABY. 

Heating  by  steam  radiators  is  very  eflfectual,  but  more 
difficult  to  control;  moreover,  it  fails  to  aid  sufficiently  in 
ventilating.  Gas  stoves  should  never  be  employed  unless 
they  are  supplied  with  smoke-pipes  connected  with  the 
chimney  or  passing  through  a  hole  in  the  window  or  wall, 
as  otherwise  they  fill  the  air  with  the  products  of  combus- 
tion. The  open  fire-place  is  the  ideal  form  of  heating  in 
moderately  cool  weather,  although  wasteful  of  fuel.  In 
severe  weather,  however,  it  heats  too  unevenly,  making 
one  portion  of  the  room  very  hot  and  leaving  the  rest 
cold.  The  ordinary  air-tight  coal  stove  is  very  service- 
able for  heating,  but  is  of  little  use  for  ventilation.  Cer- 
tain stoves  of  special  manufacture  supply  ventilation  as 
well  as  heat.  It  is  very  important  that  stoves,  fireplaces, 
hot  registers,  radiators,  and  all  lights  in  use  be  so  guard- 
ed that  there  can  be  no  possibility  of  the  baby  burning 
itself.  A  couple  of  thermometers  should  be  placed  in 
different  parts  of  the  nursery,  away  from  the  windows  or 
the  heating  apparatus,  and  one  of  them  should  certainly 
be  near  the  floor,  since  the  air  is  often  so  much  cooler 
there,  and  a  child's  whole  body  is  so  much  closer  to  the 
floor  than  an  adult's  is.  The  temperature  ought  to  be 
kept  as  uniform  as  possible,  70°  F.  being  the  extreme 
of  heat  allowed,  and  66°  to  68°  being  a  much  better 
temperature. 

In  this  connection  must  be  mentioned  the  fact  that  in 
cold  weather  there  is  always  a  draught  of  air  from  a  win- 
dow, even  when  closed.  Weather-stripping  will  prevent 
some  of  this,  but  the  greater  part  of  it  is  due  to  the  chill- 
ing of  the  air  by  the  cold  glass.  This  is  remedied  to  a 
considerable  extent  by  the  use  of  double  sash,  but,  as  it 
is  not  entirely  hindered,  it  is  better  in  very  cold  weather 
not  to  allow  the  child  to  play  near  a  window,  and  per- 
haps not  upon  the  floor  at  all. 


THE  BABY'S  ROOMS.  2I9 

The  furnishing  of  the  nursery  should  be  of  such  a 
nature  that  cleanliness  can  be  strictly  enforced,  partic- 
ularly if  the  room  is  to  be  used  at  any  time  as  a  sick- 
room. 

The  floor  should  be  well  made,  with  the  boards  closely 
joined  and  smooth,  all  the  cracks  and  holes  stopped  with 
putty,  and  the  whole  painted  or,  still  better,  finished  with 
varnish  or  oil  in  the  natural  wood.  If  the  floor  is  old 
and  poor  it  may  be  covered  with  oil-cloth.  Carpeting  of 
some  sort  is  an  essential,  but  it  had  better  not  be  tacked 
to  the  floor.  If  made  in  the  form  of  one  or  more  rugs, 
both  they  and  the  floor  can  be  cleaned  more  easily. 

The  walls  of  the  room  are  best  painted  a  bright,  cheer- 
ful tint,  and  the  ceiling  likewise.  If  paint  cannot  be  used, 
a  wall-paper  may  be  chosen  which  can  be  washed.  Paper 
of  this  nature,  coated  with  a  waterproof  varnish,  can  read- 
ily be  obtained.  It  will  bear  sponging  with  plain  water, 
but  soap  may  injure  it.  The  wall-paper  ought  not  to  con- 
tain colors  made  with  arsenic,  and  any  old  paper  ought  to 
be  removed  previous  to  repapering.  Some  large  open 
shelves  against  the  wall  are  a  very  great  convenience. 
Bright-colored,  cheap  pictures  may  adorn  the  room. 
More  expensive  ones  are  to  be  tabooed,  since  circum- 
stances may  arise,  such  as  the  occurrence  of  some  con- 
tagious disease,  which  may  render  it  advisable  to  destroy 
them. 

An  important  matter  is  the  fitting  of  all  windows  with 
firm  bars  to  prevent  the  children  from  falling  out.  There 
should  also  be  a  swinging  or  sliding  gate  in  the  doorway 
to  keep  the  baby  from  reaching  the  stairway.  The  latch 
to  the  gate  must,  of  course,  be  out  of  reach,  on  the  side 
away  fromi  the  nursery. 

The  furniture  of  the  nursery  should  be  strong,  light, 
plain,  and   easily  cleaned.     Upholstered  pieces  are   not 


220  THE    CARE    OF   THE   BABY. 

desirable.  Both  large  and  small  chairs,  with  and  without 
rockers,  are  needed,  and  a  low  table  at  which  the  chil- 
dren can  play  and,  if  desired,  take  their  meals.  None 
of  these  articles  should  have  sharp  corners,  and  the  rock- 
ing-chairs are  better  if  of  the  swinging  style  without  visible 
rockers.  There  is  also  needed  a  "nursery  chair" — a 
little  wicker  or  wooden  chair  with  a  hole  in  the  seat  and 
a  place  for  the  proper  vessel  below.  This  chair  should 
never  be  used  for  any  other  than  the  one  purpose.  Some 
tall  liofht-screens  are  very  ser\'iceable  articles  for  the  cut- 
ting  off  of  lights  and  draughts. 

Much  of  what  has  been  said  sounds  as  though  the  nur- 
sery were  to  be  a  bare  and  ugly  room,  but  this  is  far  from 
being  the  case.  There  is  a  large  range  for  the  exhibition 
of  taste  in  furnishing.  The  carpet  may  be  as  pretty  as 
one  wishes,  although  it  had  better  be  inexpensive. 
Painted  walls  can  always  be  made  to  look  well  if  the 
tints  are  good.  In  addition,  the  room  may  be  provided 
with  a  canary  bird,  the  pictures  referred  to,  a  globe 
of  gold-fish,  some  growing  plants,  and  similar  objects. 
Such  a  nursery,  when  occupied  by  a  child  happy  with  its 
to}-s,  cannot  but  present  as  pretty  a  sight  as  one  could 
desire.  It  may  be  said  here  that  growing  and  flowering 
plants,  with  possibly  the  exception  of  those  producing  a 
heavy  odor,  are  never  injurious  in  the  nursery,  either  by 
day  or  by  night,  and  are  perhaps  even  beneficial. 

The  nursery  should  be  kept  scrupulously  clean.  Be- 
sides the  daily  dusting,  the  rugs  should  be  taken  up  once 
a  week,  and  the  floor,  as  well  as  the  furniture  and  wood- 
work in  general,  washed  with  a  damp  cloth.  The  wiping 
off  of  the  walls  from  time  to  time  must  not  be  forgotten. 
No  food  or  empty  dishes  or  nursing- bottles  should  be 
allowed  to  stand  -about,  and  soiled  diapers  or  receptacles 
containinor  urine  or  evacuations  from  the  bowels  must  be 


THE   BABY'S  ROOMS.  221 

promptly  removed.  Closets  should  be  inspected  fre- 
quently, lest  something  unpleasant  have  been  put  away 
in  them.  In  fact,  every  precaution  must  be  taken  to 
keep  the  air  sweet  and  clean. 

The  effort  to  preserve  the  air  pure  suggests  the  question 
regarding  the  stationary  wash-stand.  There  is  a  great 
prejudice  among  many  against  them.  A  well-trapped 
stationary  wash-stand  fitted  with  the  best  modern  traps, 
and  with  additional  careful  trapping  of  the  main  drain- 
pipe of  the  house  before  it  passes  to  the  sewer,  is  probably 
entirely  devoid  of  danger  if  flushed  often  and  if  inspected 
by  a  good  plumber  at  frequent  intervals.  Nevertheless, 
since  severe  sickness  is  believed  to  result  from  draining 
which  is  not  so  perfect,  it  is  sometimes  thought  better  to 
have  no  plumbing  at  all  in  either  the  day  or  the  night  nur- 
sery. A  wash-stand  of  doubtful  plumbing  may  either  be 
plugged  with  putty  or,  still  better,  cut  off  from  the  sewer. 
Any  wash-stand  may  be  made  perfectly  safe  by  having  it 
empty  through  a  special  pipe  not  connected  with  the 
sewer  in  any  way.  It  may,  for  instance,  discharge  into  the 
rain-water  pipe  from  the  roof,  provided  this  does  not  join 
the  sewer,  as  so  many  of  them  do.  The  latter  arrange- 
ment would  be  far  worse  than  the  ordinary  one. 

Wash-stands  should  be  kept  perfectly  clean,  and  never 
used  as  slop-sinks.  They  should  be  washed  frequently 
with  a  strong  soda-solution,  ammonia,  or  a  solution  of 
copperas  or  carbolic  acid  (Appendix,  97).  This  will 
deodorize  the  pipe  on  the  room  side,  but  does  no  good 
whatever  as  a  disinfectant  if  the  plumbing  is  imperfect. 

2.  The  Night  Nursery. 
In  the  numerous  cases  in  which  a  family  cannot  arrange 
to  set  aside  a  room  especially  for  the  night  nursery,  the 
children  must  sleep  either  in  the  day  nursery  or  in  the 


222  THE    CARE    OF   THE   BABY. 

mother's  room.  Indeed,  where  there  is  but  one  child 
a  night  nursery  is  hardly  needed,  but  where  there  are 
several  children  in  the  house,  attended  by  a  nurse,  it  is  a 
very  great  convenience.  The  night  nursery  should  be 
used  whenever  the  children  sleep,  whether  by  night  or  by 
day.  The  qualifications  necessary  for  it  are  to  a  consid- 
erable extent  those  desirable  for  the  day  nursery.  Since  it 
is  so  strongly  advisable  that  a  mother  keep  some  watch 
over  her  children  at  night,  the  night  nursery  ought  to  be 
somewhere  near  the  mother's  room — indeed,  connected 
with  it  if  possible.  Ventilation  must  be  provided  for  at 
night  in  the  manner  already  described  for  the  manage- 
ment of  the  day  nursery.  The  sleeping-room  should 
also  be  thoroughly  aired  after  each  occasion  on  which  it 
is  used,  and  then  warmed  again  to  remove  all  traces  of 
dampness.  The  temperature  at  night  should  be  main- 
tained at  60°  to  65°  F.  It  is  not  best  to  throw  the  win- 
dows wideh'  open  and  to  allow  the  children  to  sleep  in  a 
cold  room.  Such  a  procedure  is  exceedingly  likely  to 
bring  on  catarrhal  troubles. 

The  furnishing  of  the  sleeping-room  is  similar  to  that 
already  described  for  the  day  nursery,  as  regards  the 
floors,  walls,  carpet,  and  the  simplicity  of  furniture. 
There  should  be  in  it  several  chairs,  a  bed  for  the  nurse, 
and  one  for  each  of  the  children.  The  beds  must  be 
carefully  placed  to  be  out  of  all  draughts.  The  use  of 
folding-  screens  is  often  a  great  aid  to  this  end. 
•  The  bath-tub  and  other  articles  for  the  toilet  may  be 
kept  either  here  or  in  the  day  nursery,  according  as  it  is 
found  most  convenient  to  make  the  children's  toilet  in 
the  one  or  the  other  place.  This  applies  also  to  the  chest 
of  drawers  which  contains  the  clothing,  and  the  low  chair 
upon  which  the  nurse  sits  when  washing  and  dressing  the 
child.     Should  the  night  nursery  be  used  for  the  morning 


THE   BABY'S  ROOMS.  223 

toilet  of  the  children,  the  temperature  should  be  elevated 
to  68°  or  70°  F.  before  it  is  performed. 

In  the  lighting  of  the  night  nursery  it  is  to  be  remem- 
bered that  the  burning  of  any  ordinary  light  consumes 
a  great  deal  of  the  oxygen  of  the  room,  besides  filling 
the  air  with  harmful  substances.  One  ordinary  gas- 
burner  uses  per  hour  as  much  pure  air  as  several  adult 
persons.  Nevertheless,  artificial  light  of  some  sort  is  a 
necessity  in  the  early  mornings  and  late  afternoons  of  win- 
ter. Gaslight  is  probably  the  least  objectionable  kind  or- 
dinarily to  be  had,  but  if  the  gas  furnished  is  of  bad  qual- 
ity the  products  of  its  combustion  will  be  more  than  usu- 
ally harmful.  In  such  a  case  oil  lamps  or  candles  should  be 
used— as,  of  course,  they  must  be  where  there  is  no  gas 
in  the  house.  Ordinarily,  oil  is  not  to  be  preferred, 
because  it  is  much  more  dangerous  from  the  chance  of 
the  lamps  exploding  or  of  being  upset  by  children. 
When  it  is  possible  to  do  so,  it  is  a  good  plan  to  have  the 
lights  placed  immediately  beneath  a  pipe  which  is  con- 
nected with  the  chimney.  This  will  carry  off  the  prod- 
ucts of  combustion,  although  it  does  not,  of  course,  pre- 
vent the  consumption  of  oxygen.  Nothing  equals  elec- 
tric lighting  for  a  nursery,  since  it  is  not  only  less  hot, 
but  consumes  no  air  at  all  and  is  destitute  of  danger  to 
the  children. 

It  is  important  that  the  sleeping-room  be  in  a  part  of 
the  house  where  quiet  can  be  preserved.  Infants  are 
very  easily  roused  by  noises,  and  the  sleep  is  disturbed 
even  if  not  entirely  driven  away. 

While  the  child  is  sleeping  in  the  daytime  the  room 
should  be  darkened.  It  is  better  that  children  be  accus- 
tomed to  sleep  without  any  light  in  the  room  at  night. 
Should  it  be  found  necessary  to  have  a  light  all  night 
long  on  account  of  the  frequent  rousings  of  the  baby,  a 


224 


THE    CARE    OF   THE    BABY. 


night-lamp  of  some  kind  is  the  best.  Different  forms 
of  this  may  be  obtained  at  the  drng-stores  (Fig.  58). 
They  are  so  constructed  that  they  will  continue  to  burn 
faintly  during  the  entire  night,  and  they  consume  a  min- 
imum of  the  oxygen  of  the  air.  A  good  form  is  provided 
with   a  small  glass  chimney,    which  has  the  advantage 


Fig.  58. — Pyramid  night-light. 

of  protecting  the  flame  from  currents  of  air  and  making  it 
steadier.  The  light  is  furnished  by  a  small  candle,  about 
an  inch  and  a  half  in  height  and  breadth,  which  is  sur- 
rounded by  a  thin  layer  of  plaster  of  Paris  to  ensure  entire 
safety.  A  dark  metal  shade  with  an  opening  on  one  side 
only  may  be  fitted  over  the  night-light  to  keep  the  rays 
from  falling  upon  the  sleeping  child.  When  a  house  is 
provided  with  an  electric  current  an  electric  lamp  of 
special  device,  giving  but  one  candle  power,  can  be  used 
as  a  night-light,  or  the  ordinary  electric  lamp  may  be 
partially  covered  by  a  dark  screen. 

3.  The  Sick-room. 

Ordinarily,  either  the  day  or  the  night  nursery  must 
serve  as  the  sick-room  as  well,  the  choice  between  them 


THE   BABY'S  ROOMS.  225 

depending  upon  circumstances.  Where,  however,  one 
of  several  small  children  in  a  family  is  taken  seriously 
ill,  quiet  and  careful  nursing  are  required,  or,  perhaps, 
isolation  on  account  of  the  disease  being  of  a  contagious 
nature.  It  is  then  almost  a  necessity  to  choose  some 
chamber  to  serve  as  a  special  sick-room  for  the  time 
being.  The  following  description  is  of  a  sick-room  suit- 
able to  meet  the  requirements  of  contagious  diseases  in 
particular: 

The  room  should  be  large  and  airy,  with  plenty  of  sun- 
light, unless  the  condition  of  the  child's  eyes  or  of  its 
nervous  system  renders  light  objectionable.  All  the  old 
ideas  about  the  ' '  darkened  room  ' '  as  appropriate  to  sick- 
ness are  things  of  the  past  among  intelligent  people. 
Even'when  the  eyes  are  inflamed  a  great  degree  of  dark- 
ening is  not  needed  if  a  screen  will  serve  to  give  suffi- 
cient protection.  The  room  should  be  at  the  top  of  the 
house,  if  possible,  and  on  an  entirely  different  floor  from 
that  containing  rooms  occupied  by  other  members  of  the 
family,  particularly  children.  All  unnecessary  articles 
of  furniture  should  be  removed,  and  pictures,  curtains, 
and  carpetings  put  away  if  they  have  any  value.  Chests 
of  drawers  and  closets  in  the  room  should  be  emptied  of 
their  contents.  If  it  is  desirable  to  keep  the  apartment 
from  looking  bare,  some  cheap  curtains  may  be  placed  at 
the  windows,  and  one  or  two  old  small  rugs  or  pieces  of 
carpet  be  laid  upon  the  floor.  These  may  be  destroyed 
when  the  illness  is  over.  Great  care  must  be  taken  to 
preserve  strict  cleanliness.  The  floor  and  furniture 
should  be  wiped  off"  with  a  damp  cloth  at  freqiient  inter- 
vals, but  no  sweeping  can  be  permitted.  No  empty 
dishes  with  remnants  of  food  and  no  offensive  substances 
can  be  allowed  to  remain. 

It  is  difficult,  and  sometimes  impossible,  to  prevent  the 

15 


226  THE    CARE    OF  THE  BABY. 

disease  from  spreading  through  the  house.  Certain  pre- 
cautions regarding  the  room  are  necessary,  but  to  be  of 
value  they  must  be  of  a  radical  nature.  Vessels  contain- 
ing so-called  "disinfectant"  substances  standing  about 
the  room  are  absolutely  useless,  and  simply  serve  to 
make  a  bad  smell.  If  the  house  permits  of  having 
another  room,  large  or  small,  opening  into  the  sick-room, 
the  task  is  much  lighter.  A  sheet  constantly  moistened 
with  a  disinfectant  solution  (Appendix,  97,  99)  should  be 
hung  at  the  outer  doorway  of  this  anteroom,  and  the  door 
be  kept  closed.  Whether  such  a  sheet  actually  does  any 
good  is  often  questioned.  As  it  can  do  no  harm,  and  may 
perhaps  stop  the  egress  of  some  of  the  disease  germs,  its 
use  is  advisable.  The  windows  of  the  anteroom  may  be 
kept  open  most  of  the  time  if  the  weather  permits,  and 
in  this  room  all  plates,  forks,  spoons,  nursing-bottles, 
etc. ,  that  have  been  used  may  first  be  washed  in  ordinary 
water  and  then  placed  in  a  disinfectant  solution  for  a 
time  (Appendix,  97).  There  should  be  in  this  room  a 
wash-tub  filled  with  this  solution,  in  which  all  linen  used 
about  the  patient  or  the  bed  can  soak  for  some  hours. 
After  this  it  may  be  wrung  out  and  placed  in  a  bucket, 
and  can  then  be  carried  to  the  laundry  without  danger 
to  the  household.  Immersion  in  boiling  water  kills  all 
germs.  Warming  of  milk  or  the  preparation  of  any 
liquid  articles  of  diet  may  be  done  in  the' anteroom,  and 
anything  brought  from  the  kitchen  or  elsewhere  in  the 
house  may  be  received  by  the  nurse  at  the  door  of  this 
room  and  then  taken  to  the  sick-room. 

When  the  illness  is  over  the  sick-room  and  anteroom 
must  be  thoroughly  disinfected.  The  floors  must  be  washed 
with  carbolic  acid  or  corrosive  sublimate  (Appendix,  97, 
100,  loi),  and  the  walls  and  ceilings,  if  painted,  be  treated 
in  the  same  manner.     Paper  on  the  walls,  if  it  cannot 


THE  BABY'S  ROOMS.  227 

be  washed,   should  be  removed   and  replaced    by   new. 
The    furniture    and    bedsteads   should    be   washed  with 
the  disinfectant  solution — avoiding,  however,  the  use  of 
corrosive  sublimate  upon  metal.     The  disinfectant  solu- 
tions are  very  poisonous  if  swallowed,  and  must  be  used 
with  care.     If  the  mattresses  and  pillows  are  well  reno- 
vated by  steam  and  re-covered,   they  are  entirely  safe 
but  if  they  are  small  and  old  and  can  well  be  spared  it  is 
best  to  destroy  them.     In  some  of  the  larger  cities  the 
health  authorities  will  undertake  the  thorough  disinfec- 
tion of  articles  of  this  kind.     As  a  final  additional  pre- 
caution in  disinfecting  the  room,  it  has  been  the  custom 
to  burn  sulphur  in  it,  although  it  is  still  disputed  how 
effectual  this  is.     The  health  authorities  will  attend  to 
this  also  if  desired,   but  the  nurse  or  mother  can  do  it 
just   as  well.      Sulphur   fumigators   come   already  pre- 
pared  for    the    purpose,    and   with    printed    directions. 
They  may  be  had  of  the  leading  druggists.      In  place 
of  these  the  broken   roll   sulphur  may  be  placed   in  a 
tin  vessel,  slightly  moistened  with  alcohol,  and  ignited. 
Three  pounds  of  sulphur  are  required  for  every  thou- 
sand feet  of  air-space  in  the  room.     The  windows  of  the 
room  should  be  closed  tightly,  and  all  the  cracks  about 
them  and  the  doors,  as  well  as  the  key-hole,  stopped  with 
cotton  or  paper.     The  pan  of  sulphur  is  then  floated  or 
supported  in  a  tub  of  water  to  prevent  setting  fire  to  the 
floor,  the  sulphur  is  ignited,  and  the  door  closed.     If  the 
sulphur  fumigators   are   employed,   the   box   should    be 
placed  in  a  dish  half  filled  with  earth.     After  at  least  six 
hours  the  door  may  be  opened,  the  sashes  raised,  and  the 
room  well  aired.     If  it  is  not  possible  to  have  the  mat- 
tress and  pillows  steamed,   they  should  be  left   in    the 
room  during  the  fumigation,  first  partially  opening  them 
so  that  the  fumes  of  the  sulphur  may  penetrate  them 
better. 


228  THE    CARE    OF   THE   BABY. 

As  the  disinfecting  power  of  sulphur  vapor  is,  however, 
never  very  certain,  a  much  better  plan  is  the  disinfection 
of  the  room  by  formalin,  which  is  without  doubt  much 
superior  as  a  germ- destroyer.  This  may  be  volatilized  over 
a  special  lamp,  for  sale  by  druggists,  or  may  be  procured 
in  the  convenient  form  of  formalin  candles.  Two  and  a 
quarter  ounces  of  formalin  are  required  for  every  thous- 
and feet  of  air  space.  Yet  even  formalin  vapor  has  but 
slight  penetrating  power,  and  articles  which  are  to  be 
disinfected  must  be  thoroughly  exposed  to  it. 

The  requirements  of  the  sick-room  are,  of  course, 
modified  somewhat  if  the  disease  is  not  contagious. 
There  is  no  need  of  an  anteroom  or  of  moistened  sheets 
and  the  like.  It  is  still  useful  to  have  the  room  v/ell  out 
of  the  way  if  the  disease  is  one  which  demands  quiet, 
and  it  is  just  as  well,  too,  to  have  no  unnecessary  furni- 
ture in  it.  The  practice  of  covering  tables  and  shelving 
with  all  the  bottles  and  boxes  of  medicine  which  have 
been  in  use  since  the  illness  began  renders  the  room  very 
unsightly  and  adds  greatly  to  the  evidence  of  sickness, 
besides  opening  up  the  possibility  of  giving  the  wrong 
remedy.  Medicines  no  longer  required  should  be  re- 
moved entirely,  and  those  still  in  use  should  be  concealed 
in  a  convenient  place. 

The  veutilation  and  heating  of  any  sick-room  are  mat- 
ters of  the  greatest  difficulty.  While  fresh  air  is  even 
more  important  than  during  health,  yet  in  many  diseases 
the  child  is  peculiarly  susceptible  to  draughts  and  to 
changes  of  temperature.  Very  often  the  same  method 
of  window  ventilation  can  be  employed  in  the  sick-room 
as  recommended  for  use  in  the  nursery,  provided  the 
bed  be  carefully  protected  against  draughts.  Sometimes 
additional  ventilation  may  be  secured  by  covering  the 
patient  entirely  with  the  bed-clothes  and  opening   the 


THE  BABY'S  ROOMS.  229 

windows  wide  for  three  or  four  minutes.  This  plan, 
however,  makes  a  sudden  alteration  of  the  temperature 
of  the  room,  and  is  dangerous  in  many  diseases.  It 
should  not  be  done  except  by  the  advice  of  the  physician. 
In  some  cases,  as  in  measles,  scarlet  fever,  or  any  disease 
of  the  lungs  or  bronchial  tubes,  it  often  seems  impossible 
to  open  the  windows  in  the  slightest  degree  without 
danger  of  giving  the  child  cold.  Where  there  is  an  open 
fire-place  or  a  good  ventilator  in  tlie  room  the  difficulty 
is  largely  solved,  as  either  of  these  will  serve  to  provide 
sufficient  ventilation,  the  pure  air  entering  by  the  cracks 
of  the  windows  and  doors;  but  even  with  this  method 
we  must  be  on  the  lookout  for  draughts,  so  susceptible 
to  them  do  children  with  these  diseases  become.  The 
existence  of  currents  of  air  can  be  sought  for  by  going 
about  the  room  with  a  lighted  candle  or  a  burning  match 
and  testing  the  cracks  of  doors,  windows,  closets,  wash- 
boards, etc.  It  is  not  that  we  wish  to  stop  all  entrance 
of  air  from  these  places,  since  that  would  interfere  with 
the  foul  air  going  out.  It  is  only  necessary  that  we  dis- 
cover where  the  air  currents  are,  that  we  may  place  the 
bed  so  that  it  is  not  exposed  to  them.  In  the  absence  of 
a  fire-place,  in  these  susceptible  cases,  ventilation  must 
be  procured  from  an  adjoining  room  where  the  air  is  kept 
fresh  and  warm. 

As  a  means  of  rapidly  deodorizing  a  room,  the  burning 
of  aromatic  fumigating  pastilles,  to  be  procured  in  the 
drug-stores,  is  very  serviceable.  Burning  of  coffee  has 
much  the  same  effect.  Of  course,  nothing  of  this  sort  in 
any  way  takes  the  place  of  ventilation. 

In  some  diseases,  particularly  those  of  the  throat  or  the 
lungs,  it  may  be  desirable  to  have  the  air  kept  constantly 
moist.  This  may  be  accomplished  by  boiling  water  in  a 
flat,  shallow  pan  over  an  alcohol  flame.     If  it  is  desired 


230 


THE    CARE    OF   THE   BABY. 


to  bring  the  moisture  still  closer  to  the  child,  water  may 
be  boiled  in  a  kettle,  and  a  tube  connected  with  the 
spout  may  be  brought  close  to  the  face,  taking  care,  how- 
ever, that  it  is  far  enough  removed  to  avoid  too  great 
heat.  We  do  not  desire  to  give  the  child  steam,  but 
water  vapor.  An  apparatus  for  this  purpose,  known  as 
the   croup  kettle  (Fig.   59),  may  be  purchased  from  the 


Fig.  59. — Croup  kettle.  Fig.  60. — Steam  atomizer. 

instrument-maker  or  druggist.  A  very  satisfactory  appa- 
ratus for  producing  moisture  in  the  room  is  the  steam 
atomizer,  for  sale  by  druggists  and  instrument-makers 
(Fig.  60).  The  bringing  of  the  vapor  close  to  the  patient 
is  aided  still  further  by  draping  a  couple  of  blankets  over 
the  bed  to  form  a  "  croup  tent^''''  so  that  they  fall  down 
well  about  it,  and  are  open  at  one  side  only,  like  a  tent 
door  (Fig.  61).  Broom-handles  fastened  upright,  one  at 
each  corner  of  the  crib,  and  connected  by  cord  at  their 
tops,  form  a  framework  of  the  proper  height  to  support 


THE  BABY'S  ROOMS. 


231 


the  tent.  Sometimes  a  croup  tent  may  be  improvised  by 
fastening  an  open  umbrella  over  the  child  in  bed  and 
draping  the  blankets  over  that.  Where  it  is  desired  to 
make  the  vapor  aromatic  with  such  substances  as  turpen- 


FlG.  61.— Cl'ullp  tout. 

tine,  oil  of  pine,  oil  of  eucalyptus,  and  the  like,  the  best 
way  is  to  pour  these  into  the  shallow  pan  of  boiling  water 
or  the  croup  kettle  referred  to,  being  careful  to  avoid  the 
flame.  (See  Appendix,  103.)  Accidents  from  fire  may 
easily  occur  in  using  a  croup  tent  unless  precautions  are 
taken.  Many  alcohol  lamps  are  apt  to  flame  up  badly. 
On  that  account  the  little  lamps  in  which  the  alcohol  is 
poured  on  asbestos  covered  with  wire  netting  are  to  be 
preferred,  or,  still  better,  a  gas  flame  from  a  Bunsen 
burner  or  a  little  gas  heater.  The  coverings  of  the  tent 
consist  of  blankets  on  account  of  the  inflammability  of 
sheets. 

The  temperature  of  the  sick-room  should  be  very  uni- 


232 


777^    CARE    OF  THE  BABY. 


form,  and  should  be  about  that  of  the  day  nursery.  When 
the  air  is  being  kept  constantly  moist  the  temperature 
should  be  slightly  higher. 

In  the  sick-room  or  in  the  day  nursery  or  night  nursery 
there  should  be  a  medicine-chest  or  wall-closet.  Here 
should  be  placed  such  remedies  and  appliances  as  a 
mother  is  justified  in  using  herself  A  list  of  articles 
which  should  be  constantly  kept  in  the  medicine-closet, 
ready  for  use  in  cases  of  emergency,  will  be  found  in 
Appendix,  ii6.  No  dangerous  medicine  should  be 
placed  in  this  closet,  except  under  special  precautions. 
Bottles  containing  laudanum  or  paregoric,  belladonna  and 
other  poison,  or  any  fluids  to  be  used  externally  should 

never  be  placed  here  unless 
of  such  a  nature  that  they 
may  be  recognized  readily 
even  in  the  dark.  If  this 
precaution  is  not  followed, 
some  dreadful  accident  may 
happen.  A  "poison-guard" 
may  be  had  in  the  drug-stores. 
It  consists  of  a  little  wooden 
ball  with  a  chain  attached 
(Fig.  62).  It  is  to  be  fastened 
to  the  neck  of  the  bottle,  and 
serves  to  call  attention  to  the 
fact  that  the  contents  are  dan- 
gerous, or  only  to  be  used  ex- 
ternally. There  is  a  still  better  device,  consisting  of  a 
bottle  moulded  with  points  projecting  after  the  fashion 
of  cut-glass  (Fig.  63).  The  dangerous  nature  of  the 
contents  is  perceived  the  moment  the  hand  touches  it. 
All  the  household  medicines  and  the  articles  for  use  in 
emergencies  should  invariably  be  kept  in  the  closet,  and 


Fig.  62. — Bottle 
with  poison-guard. 


Fig.  63. —  Poi- 
son-bottle. 


THE  BABY'S  ROOMS.  233 

nothing  else  should  be  placed  there.  In  this  way  there 
will  be  no  confusion  when  a  mother  wants  anything  in  a 
hurry.  Do  not  keep  all  the  half-used  medicines  remain- 
ing from  what  the  doctor  has  ordered  at  various  times.  A 
few  of  them  might  be  of  service  in  the  future,  but  the 
majority  were  good  only  for  the  occasion  when  ordered, 
and  the  closet  will  soon  be  filled  to  overflowing  with 
them.  Do  not  forget  to  keep  the  closet  locked,  and  the 
key  in  a  safe  but  accessible  place.  I  have  known  of  a 
little  child,  with  a  fondness  for  "playing  doctor," 
seriously  drugging  the  baby  of  the  family  as  a  result  of 
the  neglect  of  this  precaution. 

A  very  serviceable  article  for  use  in  the  sick-room  or 
nursery  is  a  small  nursery  refrigerator,  which  serves  to 
keep  ice  or  milk  or  other  foods  during  the  night.  As 
ordinarily  made  this  consists  of  a  small  metal  vessel, 
eighteen  inches  or  two  feet  long,  with  the  lid,  bottom, 
and  sides  of  two  layers — the  outer  one  of  tin  and  the 
inner  of  zinc — with  a  narrow  space  for  air  or  some  non- 
conducting packing  between  them.  The  Calcutta  cooler 
may  sometimes  be  used  in  place  of  a  nursery  refrigerator. 
It  consists  of  a  cylinder  covered  with  a  porous  non-con- 
ducting material,  and  large  enough  to  hold  a  piece  of  ice 
and  one  or  two  bottles.  A  simple  method  of  preventing 
ice  from  melting  is  to  put  it  into  a  tin  or  wooden  pail, 
around  and  rising  above  which  is  a  hood  of  several  layers 
of  newspaper.  The  paper  is  gathered  together  and  tied 
above  the  ice. 

Some  arrangement  for  the  heating  of  food  at  night  is 
serviceable  during  illness.  There  are  various  appliances 
made  to  fit  over  a  gas-jet  or  on  the  chimney  of  an  oil-lamp, 
and  upon  which  a  cup  or  other  vessel  may  be  heated.  In 
place  of  these  a  small  alcohol  pocket-stove  can  be  pro- 
cured. A  vessel  for  warming  the  food  has  been  described 
on  page  154. 


234  the  care  of  the  baby. 

4.  The  School-room. 

Unfortunately,  the  furnishing  and  the  regulating  of  the 
school-room  are  generally  beyond  our  control.  We  can- 
not here  consider  at  length  the  method  of  constructing  a 
school-building  to  furnish  the  proper  light,  heat,  and 
ventilation  so  greatly  to  be  desired.  It  is  certain  that 
colds,  near-sightedness,  backache,  headache,  and  various 
nervous  derangements  may  be  expected  as  the  result  of  a 
defect  in  the  hygiene  of  the  school-room,  even  though  no 
mental  overwork  be  indulged  in.  If  the  nursery  with 
two  or  three  inmates  should  be  well  ventilated,  how 
much  more  important  is  the  ventilation  where  a  large 
number  of  children  are  collected  in  one  room!  Parents 
should  refuse  to  send  their  children  to  a  school,  however 
desirable  in  other  respects,  if  it  is  plainly  apparent  that 
there  are  going  to  be  constant  draughts  on  the  one  hand 
or  great  lack  of  proper  air-space  on  the  other. 

In  rural  districts,  or  even  in  the  city,  parents  who  em- 
ploy a  nursery  governess  may  prefer  their  children  to  be 
taught  at  home.  In  such  case  the  day  nursery  will  often 
be  the  room  chosen,  and  its  fitting  qualities  require  no 
further  comment.  In  other  instances  several  families 
may  combine  in  the  employment  of  a  governess,  and 
will  desire  to  select  in  one  of  the  dwellings  a  room  which 
will  be  suitable  for  the  purpose.  On  this  account  a  few 
remarks  will  not  be  out  of  place  upon  some  of  the  re- 
quirements of  the  ideal  school-room,  as  well  as  upon 
some  of  the  dangers  of  an  unsuitable  room.  They  may, 
indeed,  be  useful  even  to  those  whose  children  regularly 
attend  school,  for  the  subject  is  one  with  which  we  all 
should  be  somewhat  familiar.  One  of  the  most  im- 
portant considerations  in  this  connection  is  the  danger 
of  the  production  of  spinal  deformity.     A  lateral  curv- 


THE   BABY'S  ROOMS.  235 

ature  of  the  spine  is  likely  to  develop,  especially  in  girls 
with  weak  muscles,  as  the  result  of  sitting  in  school  with- 
out proper  support  to  the  back,  or  of  improper  position 
assumed  while  writing  or  while  standing  at  recitation. 
To  avoid  this  deformity  it  is  important  that  the  child 
stand  squarely  upon  both  feet  when  reciting,  and  espe- 
cially that  the  desk  and  chair  be  of  a  proper  kind.  Many 
of  these  are  very  harmful,  and  produce  a  habit  of  stoop- 
ing with  rounding  of  the  shoulders  that  may  never  be 
recovered  from.  The  chair  should  allow  the  child's  feet 
to  rest  upon  the  floor,  and  should  have  a  back  which 
thoroughly  supports  the  lower  portion  of  the  spine.  This 
latter  feature  is  of  the  greatest  importance,  but  is  very 
frequently  wanting.  The  upper  part  of  the  chair-back 
should  slope  slightly  backward  to  support  the  remain- 
der of  the  spine  when  the  child  is  at  rest.  In  some 
excellent  chairs  the  chair-back  does  not  extend  as  high 
as  the  shoulders,  since  no  need  of  support  is  felt  if  the 
hollow  of  the  spine  and  the  part  below  it  are  properly 
sustained.  The  low-backed  chair  is  the  only  form  that 
gives  support  when  the  child  is  writing,  since  it  allows 
of  the  chair  being  kept  close  to  the  desk  without  the 
elbows  hitting  anything  behind  them. 

Th'e  desk-lid  is  often  too  high,  and  as  a  result  the  right 
elbow  is  too  much  elevated.  This  produces  a  twist  of 
the  spine,  which  after  a  while  becomes  permanent  as  a 
lateral  curvature.  (Compare  illustration  on  page  301). 
The  edge  of  the  desk-lid  nearest  to  the  child  should 
reach  only  just  as  high  as  the  elbows,  and  should  over- 
lap the  edge  of  the  seat.  The  child  should  face  the  desk 
squarely,  with  both  arms  resting  upon  it.  A  desk  which 
is  too  high  and  is  not  properly  placed  not  only  tends  to 
produce  deformity  of  the  spine,  but  also  brings  the  book 
on  it  too  close  to  the  eyes  and  produces  near-sightedness 


236  THE    CARE    OF  THE  BABY. 

as  a  result.  Other  affections  of  the  eyes,  followed  by 
headache  and  other  symptoms,  result  from  the  use  of 
them  in  an  insufficient  light  or  from  facing  too  bright  a 
ligfht.  The  windows  should  be  at  the  back  of  the  room 
and  upon  one  side,  preferably  the  left,  since  this  does 
away  with  trying  cross-lights.  Of  course,  the  same  pre- 
caution regarding  the  proper  arrangement  of  lights  must 
be  looked  after  when  the  child  is  reading  at  home. 

As  to  the  actual  size  of  the  school-room  required,  it  is 
calculated  that  there  should  be  300  cubic  feet  of  air-space 
for  every  scholar.  For  a  class  of  forty  scholars  this  will 
require  a  room  28  by  32  by  13^  feet  (Lincoln).  To  render 
this  amount  of  air-space  sufficient  to  keep  the  room  in  a 
proper  condition  it  is  necessary  that  the  air  be  completely 
changed  six  times  in  an  hotir.  Manifestly  an  ordinary 
school-room  with  closed  windows  and  no  efficient  system 
of  ventilation  does  not  accomplish  this.  No  wonder  the 
poor  children  grow  sleepy  and  find  study  hard  work! 


CHAPTER    XI. 

THE  SICK  BABY. 

This  chapter,  necessarily  a  somewhat  long  one,  must 
not  be  viewed  as  an  effort  to  render  a  mother  capable  of 
"doctoring "  her  own  children.  Such  an  attempt  would 
be  a  hopeless  one,  inasmuch  as  with  the  treatment  of  a 
sick  baby  the  experienced  physician  often  has  his  hands 
far  more  than  full.  It  is  intended  only  to  impart  such 
knowledo^e  as  will  enable  a  trained  nurse  or  a  mother — 
especially  one  living  far  away  from  medical  advice — to 
know  whether  the  child  is  ill,  what  is  probably  the  nature 


THE   SICK  BABY. 


237 


of  its  ailment,  whether  she  shall  send  for  a  physician, 
what  she  shall  do  before  he  comes,  and  how  she  shall 
carry  out  his  directions  afterward.  The  actual  treatment 
of  disease,  except  of  the  simplest  kind,  cannot  be  con- 
sidered here.  It  is  far  wiser  for  the  mother  to  meddle 
very  little  with  the  baby's  illnesses. 

We  may  conveniently  divide  our  subject  into — 
I.   The  Features  of  Disease  ; 
II.   The  Management  of  Sick  Children  ; 

III.   The  Disorders  of  Childhood. 

I.  The  Features  of  Disease. 

We  have  already  considered,  in  Chapter  II.,  the  cha- 
racteristics of  a  healthy  baby,  often  called  ^^  \h^  features 
of  healthy  Bearing  these  in  mind,  we  can  now  deal  with 
some  of  the  '  ''features  of  disease^ ' '  in  order  that  we  may  see 
what  can  be  learned  by  close  observation  of  a  sick  child. 

T\\e. position  assumed  in  sickness  is  a  matter  of  impor- 
tance. A  child  feverish  or  in  pain  is  usually  very  restless 
even  when  asleep.  When  awake  it  desires  constantly  to 
be  taken  up,  put  down  again,  or  carried  about.  Some- 
times, however,  at  the  beginning  of  an  acute  disease  it 
lies  heavy  and  stupid  for  a  long  time.  In  prolonged  ill- 
nesses and  in  severe  acute  disorders  the  great  exhaustion 
is  shown  by  the  child  lying  upon  its  back,  with  its  face 
turned  toward  the  ceiling,  in  a  condition  of  complete 
apathy.  It  may  lie  like  a  log,  scarcely  breathing  for 
days  before  death  takes  place.  Perfect  immobility  may 
also  be  seen  in  children  who  are  entirely  unconscious 
although  not  exhausted.  A  constant  tossing  off  of  the 
covers  at  night  occurs  early  in  rickets,  but,  of  course,  is 
seen  in  many  healthy  infants,  especially  if  they  are  too 
warmly  covered.  A  baby  shows  a  desire  to  be  propped 
up  with  pillows  or  to  sit  erect  or  to  be  carried  in  the 


238  THE    CARE    OF   THE   BABY. 

mother's  arms  with  its  head  over  her  shoulder  whenever 
breathing  is  much  interfered  with,  as  in  diphtheria  of  the 
larynx  and  in  aflfections  of  the  heart  and  lungs.  The 
constant  assumption  of  one  position  or  the  keeping  of  one 
part  of  the  body  still  may  indicate  paralysis.  When, 
however,  a  cry  attends  a  forcible  change  of  position,  it 
shows  that  the  child  was  still  because  movement  caused 
pain.  Sleeping  with  the  mouth  open  and  the  head 
thrown  back  often  attends  chronic  enlargement  of  the 
tonsils  and  the  presence  of  adenoid  growths  in  young 
children,  although  it  may  be  seen  in  other  affections 
which  make  breathing  difficult.  In  inflammation  of  the 
brain  the  head  is  often  drawn  far  back  and  held  stiffly  so. 
Sometimes,  too,  in  this  disease  the  child  lies  upon  one 
side  with  the  back  arched,  the  knees  drawn  up,  and  the 
arms  crossed  over  the  chest.  A  constant  burying  of  the 
face  in  the  pillow  or  in  the  mother's  lap  occurs  in  severe 
inflammation  of  the  eyes. 

The  gestures  are  often  indicative  of  disease.  Babies 
frequently  place  the  hands  near  the  seat  of  pain  :  thus  in 
slight  inflammation  of  the  mouth  they  tend  to  put  the 
hand  in  the  mouth  ;  in  earache  to  move  it  to  the  ear  ; 
and  in  headache  to  raise  it  to  the  head.  In  headache  or 
in  affections  of  the  brain  they  sometimes  pluck  at  the 
hair  or  the  ears,  although  they  may  often  do  this  when 
there  is  no  such  trouble.  Picking  at  the  nose  or  at  the 
opening  of  the  bowel  is  seen  in  irritation  of  the  intestine 
from  worms  or  oftener  from  other  cause.  The  move- 
ments of  the  hands  are,  however,  frequently  mislead- 
ing imless  their  apparent  meaning  is  corroborated  by 
other  symptoms.  For  instance,  a  child  with  pain  in  its 
chest  may  sometimes  refer  it  to  the  abdomen  and  place 
its  hands  there.  In  approaching  convulsions  the  thumbs 
are  often  drawn  tightly  into  the  palms  of  the  hands  and 


THE   SICK  BABY.  239 

the  toes  are  stiffly  bent  or  straightened.  Very  young 
babies,  however,  are  apt  to  do  this,  although  healthy. 
The  alternate  doubling  up  and  straightening  of  the  body, 
with  squirming  movements,  making  of  fists,  kicking, 
and  crying,  is  an  indication  of  colic.  This  is  especially 
true  if  the  symptoms  come  on  suddenly  and  disappear  as 
suddenly,  perhaps  attended  by  the  expulsion  of  gas  from 
the  bowel. 

The  color  of  the  skin  is  often  altered  in  disease.  It  is 
yellow  in  jaundice,  and  is  bluish,  especially  over  the 
face,  in  congenital  heart  disease.  There  is  a  purplish 
tint  around  the  eyes  and  mouth,  with  a  prominence  of 
the  veins  of  the  face,  in  weakly  children  or  in  those  with 
disordered  digestion.  A  pale  circle  around  the  mouth 
accompanies  nausea.  The  skin  frequently  acquires  an 
earthy  hue  in  chronic  diarrhoea,  and  is  pale  in  any  con- 
dition in  which  the  blood  is  impoverished,  as  in  Bright' s 
disease,  rickets,  consumption,  or  any  exhausted  state. 
Flushing  of  the  face  accompanies  fever,  but  besides  this 
there  is  often  seen  a  flushing  without  fever  in  older 
children  the  subjects  of  chronic  disorders  of  digestion. 
Sudden  flushing  or  paling  is  sometimes  seen  in  disease 
of  the  brain. 

The  expression  of  the  face  varies  with  the  disease. 
Young,  healthy  babies  have  little  expression  of  any 
kind  except  that  of  wondering  surprise.  In  whooping- 
cough  and  measles  the  face  is  swollen  and  somewhat 
flushed,  giving  the  child  a  heavy,  stupid  expression. 
There  is  also  swelling  of  the  face,  especially  about  the 
eyes,  in  Bright' s  disease.  Repeated  momentary  crossing 
of  the  eyes  often  indicates  approaching  convulsions.  In 
very  severe  acute  diarrhoea  it  is  astonishing  with  what 
rapidity  the  face  will  become  sunken  and  shrivelled,  and  so 
covered  with  deep  lines  that  the  baby  is  almost  unrec- 


240  77//:    CARE    01-    THE   BABY. 

ognizable.  The  same  thinj;^  occurs  more  slowly  in  the 
condition  commonly  known  as  }>iaras))ius.  Often  the 
face  has  an  expression  of  distress  in  the  beginning  of 
any  serious  disease.  If  the  edges  of  the  nostrils  move  in 
and  out  with  breathing,  we  may  suspect  some  difficulty 
of  respiration  such  as  attends  pneumonia.  The  baby 
sleeps  with  its  eyes  half  open  in  exhausted  conditions  or 
when  suffering  pain.  Chewing  movements  during  sleep 
result  from  disordered  digestion,  and  a  smile  in  very 
young  infants  often  has  the  same  cause. 

The  Z/^^^^y  exhibits  certain  noteworthy  features.  Excess- 
ive perspiration  when  sleeping  is  an  early  symptom  of 
rickets.  It  must  be  remembered,  however,  that  any  de- 
bilitated child  may  perspire  more  or  less  when  asleep, 
and  that  even  healthy,  full-blooded  children  are  some- 
times affected  if  the  weather  is  very  hot.  Both  in  this 
disease  and  in  hydrocephalus  (water  on  the  brain)  the  face 
seems  small  and  the  head  large,  but  in  the  former  the  head 
is  square  and  flat  on  top,  while  in  the  latter  it  is  of  a  some- 
what globular  shape.  The  fontanelle  is  prominent  and 
throbs  forcibly  in  inflammation  of  the  brain,  is  too  large 
in  rickets  and  hydrocephalus,  bulges  in  the  latter  affec- 
tion, and  is  sunken  in  debilitated  states.  The  disfigure- 
ments of  the  head  immediately  following  birth  will  be 
described  later  in  this  chapter  (p.  297). 

The  chest  e.yi\\\h\\.s  a  heaving  movement  with  a  drawing 
in  of  the  spaces  between  the  ribs  in  any  disease  in  which 
breathing  is  difficult.  A  chicken-breasted  chest  is  .seen 
in  Pott's  disease  of  the  spine,  and  to  some  extent  in  bad 
cases  of  enlargement  of  the  tonsillar  ti.ssue  ;  a  "violin- 
shaped  "  chest  in  rickets  ;  a  bulging  of  one  side  in  pleu- 
risy with  fluid  ;  and  a  long,  narrow  chest,  with  a  general 
flattening  of  the  upper  part,  in  older  children  predisposed 
to  consumption. 


THE   SICK  BABY.  24 1 

The  abdomen  is  swollen  and  hard  in  colic.  It  is  also 
much  distended  with  gas  in  rickets,  and  is  constantly  so 
in  chronic  indigestion  in  later  childhood.  It  is  usually 
much  sunken  in  inflammation  of  the  brain  or  in  severe 
exhausting  diarrhoea.  It  may  be  distended  with  liquid 
in  some  cases  of  dropsy. 

The  study  of  the  cry  furnishes  one  of  the  most  valuable 
means  of  learning  what  ails  a  baby.  An  unremitting 
cry  is  usually  due  to  hunger,  or  sometimes  to  thirst,  but 
scarcely  any  cry  is  so  unappeasable  as  that  of  earache. 
We  must  remember  that  not  every  cry  that  ceases 
when  the  baby  is  nursed  is  caused  by  hunger.  Some- 
times the  cry  of  colic  will  be  temporarily  helped  in  this 
way.  Sometimes  a  persistent  cry  is  due  to  pain  of 
another  nature — such,  for  instance,  as  that  caused  by  the 
pricking  of  a  pin.  It  may  also  be  produced  by  the  in- 
tense,  constant  itching  of  eczema. 

A  paroxysmal  cry,  very  severe  for  a  time  and  then 
ceasing  absolutely,  is  probably  due  to  colic,  particularly 
if  accompanied  by  the  distention  of  the  abdomen  and 
the  movements  of  the  body  alread}^  referred  to.  If  a  child 
cries  every  time  it  is  picked  up,  it  is  probable  that  the 
pressure  upon  the  chest  while  lifting  it  gives  pain.  This 
may  be  the  result  of  rickets  or  of  pleurisy.  Crj'ing  when 
any  one  part  is  touched  suggests,  of  course,  that  there  is 
something  wrong  there.  On  the  other  hand,  a  cry  which 
is  often  loud  and  persistent,  but  which  ceases  whenever 
the  child  is  picked  up  or  amused,  is  merely  a  bad  habit 
on  the  part  of  the  infant  and  shows  lack  of  training. 
This  kind  of  cry  may  be  heard  even  early  in  infancy,  and 
is  sometimes  very  perplexing  to  the  mother.  A  sleepy 
child  has  a  fretful  cry,  often  with  rubbing  of  the  eyes 
and  other  evidences  of  its  sensations.  A  frequent, 
peevish,  whining  cry  is  heard  in  children  with  general 

16 


242  THE    CAKE    OE   THE   BABY. 

poor  health  or  discomfort.  A  sinj^le  shrill  scream  uttered 
now  and  then  is  often  heard  in  inflammation  of  the  brain. 
In  any  disease  in  which  there  is  difficnlty  in  getting 
enough  air  into  the  lungs,  as  in  pneumonia,  the  cry  is 
usually  very  short  and  the  child  cries  but  little,  because 
it  cannot  hold  its  breath  long  enough  for  it.  A  nasal 
cry  occurs  with  cold  in  the  head.  A  short  cr}-  imme- 
diately after  coughing  indicates  that  the  cough  hurts  the 
chest.  Crying  when  the  bowels  are  moved  shows  that 
there  is  pain  at  that  time.  A  loud,  violent  cry  coming 
on  suddenly  is  very  often  an  exhibition  of  temper.  A  child 
of  from  two  to  six  years,  waking  at  night  with  violent 
screaming,  is  probably  suffering  from  night-terrors.  In 
conditions  of  very  great  weakness  and  exhaustion  the 
baby  moans  feebly,  or  it  may  twist  its  face  into  the  posi- 
tion for  crying,  but  emit  no  sound  at  all.  This  latter  is 
also  true  in  some  cases  of  inflammation  of  the  larynx, 
while  in  other  cases  the  cr}-  is  hoarse  or  croupy.  Crying 
when  anything  goes  into  the  mouth  makes  one  suspect 
some  trouble  there.  If  it  occurs  with  swallowing,  it  is 
probable  that  the  throat  is  inflamed. 

With  the  act  of  crying  there  ought  always  to  be  tears 
in  children  over  three  or  four  months  of  age.  If  there 
are  none,  it  is  an  indication  that  the  disease  is  serious, 
and  their  reappearance  is  then  a  good  sign. 

The  character  of  the  cough  is  also  instructive.  A  fre- 
quent, loud,  nearly  painless  cough,  at  fiirst  tight  and  later 
loose,  is  heard  in  bronchitis.  A  short,  tight,  suppressed 
cough,  which  is  followed  by  a  grimace,  and,  perhaps,  by 
a  cry,  indicates  some  inflammation  about  the  chest,  often 
pneumonia.  There  is  a  brazen,  barking,  "croupy" 
cough  in  spasmodic  croup.  In  inflammation  of  the 
larynx,  including  true  croup,  the  cough  is  hoarse  or 
sometimes  almost  noiseless.      The  cough  of  whooping- 


THE   SICK  BABY.  243 

cough  is  SO  peculiar  that  it  must  be  described  separately 
when  considering  this  disease.  Then  there  are  certain 
coughs  which  are  purely  nervous  or  dependent  upon 
remote  affections.  Thus  the  so-called  "stomach  cough  " 
is  caused  by  some  irritation  of  the  stomach  or  bowels. 
It  is  not  nearly  so  frequent  as  mothers  suppose.  Irrita- 
tion about  the  nose  or  the  canal  of  the  ears  sometimes 
induces  a  cough  in  a  similar  way.  Enlarged  tonsils  or 
elongated  palate  or  irritation  in  the  throat  may  also  pro- 
duce a  cough. 

The  breathing  of  a  young  child,  particularly  if  under 
one  year  of  age  and  awake,  is  always  slightly  irregular. 
If  it  becomes  very  decidedly  so,  we  suspect  disease, 
particularly  of  the  brain.  A  combination  of  long  pauses, 
lasting  half  a  minute  or  a  minute,  with  breathing  which 
is  at  first  very  faint,  gradually  becomes  more  and  more 
deep,  and  then  slowly  dies  away  entirely,  goes  by  the 
name  of  "  Cheyne-Stokes  respiration"  and  is  found  in 
affections  of  the  brain.  It  is  one  of  the  worst  of  symp- 
toms except  in   infancy,   and  even  then  it  is  alarming. 

The  rate  of  respiration  is  increased  in  fever  in  propor- 
tion to  the  height  of  the  temperature  (see  page  245).  It 
is  increased  also  by  pain,  in  rickets,  and  especially  in 
some  affections  of  the  lungs.  Sixty  respirations  a  minute 
is  not  at  all  excessive  for  a  child  of  two  years  with 
pneumonia,  and  the  speed  is  frequently  decidedly  greater 
than  this. 

Breathing  is  often  very  slow  in  disease  of  the  brain, 
particularly  tubercular  meningitis.  Poisoning  by  opiates 
produces  the  same  effect.  Frequent  deep  sighing  or 
yawning  occurs  in  affections  of  the  brain,  in  faintness, 
or  in  great  exhaustion,  and  may  be  a  very  unfavorable 
symptom.  Breathing  entirely  through  the  mouth  shows 
that   the    nose    is    completely    blocked,   while   snuffling 


244  THE    CARE    OE   THE    BAHY. 

breathing-  is  the  result  of  a  partial  catarrhal  obstruction. 
A  triirgling  in  the  throat  not  accompanied  by  cough 
may  indicate  that  there  is  mucus  in  the  back  part  of  it, 
the  result  of  an  inflammation,  sometimes  slight,  some- 
times serious.  "Labored"  breathing,  in  which  the 
chest  is  pulled  up  by  each  breath  while  the  muscles  of 
the  neck  become  tense,  the  pit  of  the  stomach  and  the 
spaces  between  the  ribs  sink  in,  and  the  edges  of  the 
nostrils  move  in  and  out,  is  seen  in  conditions  where  the 
natural  ease  of  respiration  is  greatly  interfered  with,  as  in 
pneumonia,  diphtheria  of  the  larynx,  asthma,  and  the 
like.  Long-drawn,  noisy  inspirations  and  expirations  are 
heard  in  obstruction  of  the  larynx,  as  from  laryngeal 
diphtheria  or  spasmodic  croup. 

The  rate  of  the  pulse  is  subject  to  such  variations 
in  infants  that  its  examination  is  of  less  value  than 
it  would  otherwise  be.  In  early  childhood  its  ob- 
servation is  of  more  service,  although  even  then  decep- 
tive. Unusual  irregularity  is  an  important  symptom  in 
affections  of  the  brain  and  of  the  heart.  Fever  is  accom- 
panied by  an  increase  in  the  pulse-rate,  the  degree  of 
which  depends,  as  a  rule,  upon  the  height  of  the  tem- 
perature (see  p.  245).  Slowing  of  the  pulse  is  a  very 
important  symptom,  seen  particularly  in  affections  of  the 
brain,  and  sometimes  in  Bright's  disease  and  jaundice. 

The  tempei'atiire  and  the  method  of  determining  it  have 
already  been  referred  to  in  Chapter  IL  It  is  of  all  things 
important  to  remember  that  in  infancy  and  childhood  fever 
is  easily  produced  and  runs  high  from  slight  causes.  Al- 
though a  very  decided  elevation  should  render  a  mother 
anxious  to  discover  the  cause,  there  is  no  reason  why  it 
should  at  once  throw  her  into  a  paroxysm  of  fright.  Even 
slight  cold  or  the  presence  of  constipation  or  slight  dis- 
turbance of  digestion  may  in  babies  sometimes  produce  a 


THE   SICK  BABY.  245 

temperature  of  103°  or  more.  We  do  not  speak  of  fever 
unless  the  temperature  reaches  100°.  A  temperature  of 
102°  or  103°  constitutes  moderate  fever,  while  that  of  104° 
or  105°  is  high  fever,  and  above  105°  very  high.  A  tem- 
perature of  107°  is  very  dangerous,  and  is  usually  not 
recovered  from.  The  danger  from  fever  depends  not  only 
upon  its  height,  but  upon  its  duration  also.  A  temper- 
ature of  105°  may  be  easily  borne  for  a  short  time,  but  it 
becomes  alarming  if  much  prolonged. 

There  is  a  notable  tendency  to  variation  of  the  tem- 
perature of  fever  during  the  day,  the  elevation  at  night 
being  nearly  always  greater  than  in  the  morning.  We 
do  not  need  to  be  discouraged,  therefore,  should  a  child 
whose  temperature  had  diminished  considerably  in  the 
morning  have  it  become  much  higher  by  the  evening. 
On  the  other  hand,  should  a  morning  fever  be  only  as 
high  as  that  of  the  evening  before,  we  may  conclude  tliat 
the  tendency  to  elevation  is  really  greater.  A  sudden 
•fall  of  temperature  is  usually  a  favorable  sign,  but  this  is 
not  always  so,  for  unless  it  is  accompanied  by  an  improve- 
ment in  the  other  symptoms,  it  may  indicate  that  death 
is  imminent.  The  various  febrile  diseases  have  each 
their  characteristic  course  with  regard  to  the  height,  dura- 
tion, and  variation  of  temperature,  but  the  subject  is  too 
difficult  to  be  discussed  in  a  book  of  this  sort. 

With  elevation  of  temperature  from  any  cause  there  is 
a  corresponding  increase  of  the  rate  of  both  pulse  and 
respiration.  In  adults  about  eight  or  ten  beats  of  the 
pulse  and  about  two  or  three  respirations  may  be  added 
for  each  degree  of  temperature  above  normal.  This  ratio 
is  equivalent  to  about  one  additional  respiration  for  each 
three  or  four  beats  of  the  pulse.  In  children,  however, 
the  ratio  is  more  variable,  and  the  increase  in  pulse  and 
respiration  is  greater  for  each  degree  of  temperature  than 


246  THE   CARE    OF   THE   BABY. 

in  adult  life.  There  are  certain  diseases,  also,  as  pneu- 
monia, scarlet  fever,  typhoid  fever,  and  some  others, 
where  the  normal  ratio  is  not  preserved. 

Instead  of  elevation  we  sometimes  find  depression  of 
temperature  below  normal.  A  temperature  of  97°  or  less 
in  the  rectum  is  sometimes  alarming  in  children,  and 
one  of  95°  rarely  occurs  unless  the  child  is  dying.  Ex- 
haustion from  any  cause,  as  from  profuse  diarrhoea, 
obstinate  continued  vomiting,  or  hemorrhage,  is  liable 
to  produce  a  depression  of  temperature,  and  some  degree 
of  reduction  is  nearly  always  present  in  premature  infants 
and  in  those  suffering  from  insufficient  nourishment, 
anaemia,  or  chronic  diseases  of  the  heart  and  lungs.  So, 
too,  after  attacks  of  the  various  febrile  diseases  the  tem- 
perature is  liable  to  be  below  normal  for  some  days. 

The  tongue  of  newly-born  infants  is  generally  whitish, 
and  continues  to  be  so  until  the  saliva  becomes  plentiful. 
After  this  we  usually  find  it  coated  in  disturbances  of  the 
stomach  and  bowels  and  in  nearly  any  disorder  accom- 
panied by  fever,  although  not,  as  a  rule,  so  thick!}-  as  in 
adults.  Yet  we  cannot  lay  so  much  stress  on  the  coating 
of  the  tongue  in  the  early  years  of  life  as  in  later  vears, 
for  children  with  perfect  digestion  often  exhibit  coated 
tongues,  while  those  with  severe  intestinal  catarrh  may 
often  have  tongues  of  perfectly  natural  appearance.  In 
scarlet  fever  the  tongue  becomes  bright  red  after  a  few 
days,  and  in  measles  and  whooping-cough  it  is  often 
slightly  bluish.  In  the  latter  affection  an  ulcer  may, 
sometimes  be  found  directly  under  the  tongue,  where 
the  thin  membrane  binds  it  to  the  floor  of  the  mouth. 
In  thrush  the  tongue  is  covered  with  white  patches  like 
curdled  milk.  A  pale,  flabby  tongue,  marked  b}-  the 
teeth  at  its  edges,  indicates  debility  or  impaired  diges- 
tion.    In  prolonged  or  very  high  fever  the  tongue  grows 


THE   SICK  BABY.  2A7 

dry,  and  in  some  diseases  of  the  stomach  or  bowels  it 
may  look  like  raw  beef. 

Grinding  of  tJie  teetJi  is  a  frequent  symptom  in  infants 
in  whom  dentition  has  commenced.  It  generally  indi- 
cates an  irritated  nervous  system.  Most  often  this 
depends  upon  some  disturbance  of  digestion;  less  often 
upon  the  presence  of  worms.  The  symptom  is  present 
during  or  preceding  a  convulsion,  and  may  occur,  too, 
in  disease  of  the  brain.  In  some  babies  it  appears  to  be 
only  a  nervous  habit. 

The  manner  of  nursing  or  swallowing  frequently 
affords  important  information.  A  baby  whose  nose  is 
much  obstructed  or  who  has  pneumonia  can  nurse  for 
but  a  moment,  and  then  has  to  let  the  nipple  go  in  order 
to  breathe  more  satisfactorily.  If  it  gives  a  few  sucks 
and  then  drops  the  nipple  with  a  cry,  we  must  suspect 
that  the  mouth  is  sore  and  that  nursing  is  painful.  If 
it  swallows  with  a  gurgling  noise,  often  stops  to  cough, 
and  does  as  little  nursing  as  possible,  we  suspect  that  the 
throat  may  be  sore.  The  ceasing  to  nurse  at  all,  in  the 
case  of  a  very  sick  baby,  is  an  evidence  of  great  weakness 
or  increasing  stupor,  and  is  a  most  unfavorable  symptom. 

Urine  that  is  high-colored  and  stains  the  diaper,  or 
that  shows  a  thick  reddish  cloud  after  standing,  may 
accompany  fever  or  indigestion.  Sometimes  the  urine 
imder  these  conditions  is  milky  when  first  passed.  In 
some  babies  a  diet  containing  beef-juice  or  other  highly 
nitrogenous  food  will  produce  the  reddish  cloud,  or  even 
actual,  red,  sand-like  particles.  A  decidedly  yellow  stain 
on  the  diaper  occurs  when  there  is  jaundice.  The  amount 
of  urine  passed  is  scanty  in  fever,  in  diarrhoea,  and  espe- 
cially in  acute  Bright's  disease.  In  the  latter  disease  the 
urine  is  often  of  a  smoky  or  even  a  muddy  appearance. 
The  possibility  of  the  occurrence  of  this  symptom  after 


248  rnE    CARE    OF   THE   BABY. 

scarlet  fever  must  always  be  kept  in  mind,  in  order  that 
a  physician  may  be  summoned  very  quickly,  since  it  is  a 
serious  matter. 

The  boivel-movements  characteristic  of  health  have 
already  been  described.  Apart  from  the  various  altera- 
tions in  appearance  seen  in  diarrhoea  and  constipation, 
and  presently  to  be  referred  to,  we  find  that  the  passages 
are  often  putty-colored  in  disorders  of  the  liver,  frequently 
bloody  or  tarry  in  appearance  in  bleeding  within  the 
bowel,  and  liable  to  be  black  after  taking  bismuth,  char- 
coal, or  iron,  and  red  after  krameria,  kino,  or  hsematoxy- 
lin.  Infants  who  are  receiving  more  milk  than  they  can 
digest  constantly  have  whitish  lumps  in  their  stools,  or 
even  entirely  formed  but  almost  white  passages.  The 
presence  of  a  certain  amount  of  greenish  coloration  of 
the  passages  is  not  infrequent.  This  is  usually  an  evi- 
dence of  indigestion,  but  passages  which  are  yellow  when 
passed  and  turn  to  a  faint  pea-green  some  time  later  are 
not  an  indication  of  disease. 

11.  The  Management  of  Sick  Children. 

Where  a  good  trained  nurse  used  to  the  ways  of  children 
can  be  had,  the  nursing  of  a  sick  child  will  generally  go  on 
without  trouble.  Still,  no  mother  ought  to  be  without 
knowledge  on  the  subject,  and  the  majority  need  it  badly 
in  case  they  must  themselves  fill  the  nurse's  place.  The 
following  remarks,  although  descriptive  of  the  duties  of 
a  nurse,  are  intended  especially  for  the  mother  nursing 
her  own  sick  children. 

One  of  the  nurse's  chief  cares  should  be,  of  course,  to 
observe  the  child  closely  in  the  search  for  evidences  of 
disease.  Another,  and  often  a  very  difficult  one,  is  the 
administration  of  medicine  and  food.  If  the  child  has 
been  well  trained  in   habits  of  obedience,   it  will    take 


THE   SICK  BABY.  249 

what  is  given  to  it  \Yithoiit  much  objection.  If  it  is  not 
so  trained,  the  nurse  must  use  whatever  means  of  per- 
suasion will  most  easily  attain  the  desired  end,  or,  failing 
in  this,  must  exercise  the  greatest  firmness  and  insist  upon 
being  obeyed.  Very  often  the  promise  of  a  chocolate 
or  other  sweet,  some  pennies,  or  a  simple  toy  will  serve 
to  overcome  the  obstinacy.  This,  of  course,  is  rank  bri- 
ber}', and  against  all  rules  for  moral  training.  Sickness, 
however,  is  hardly  the  time  to  inculcate  principles  which 
should  have  been  taught  long  before,  and  the  taking  of 
food  and  medicine  is  so  important  that  the  end  fully  jus- 
tifies the  means.  Should  a  child  still  prove  obstinate,  it 
is  better  to  lose  little  time  in  argument  or  pleading  which 
must  be  repeated  several  times  a  day.  The  nurse  will  do 
better  if  she  promptly  take  the  child  up,  wrap  a  shawl 
closely  about  its  body  and  arms  to  prevent  interference, 
hold  its  nose  carefully,  and  then,  when  it  opens  its  mouth 
to  breathe,  insert  the  spoon  as  far  as  possible,  empty  it 
gently,  and  withdraw  it  slowly.  If  the  spoon  is  not 
withdrawn,  the  child  has  difificulty  in  swallowing.  This 
seems  like  harsh  treatment;  still,  if  it  is  done  without 
excitement  or  anger,  and  as  a  matter  of  course,  the  child 
soon  looks  upon  it  as  inevitable,  and  will  often  take  its 
medicine  quietly,  without  making  a  frequent  repetition  of 
the  procedure  necessary.  In  young  babies  the  pressure 
of  the  chin  backward  and  downward  with  the  finger  will 
often  serve  to  open  the  mouth.  Often  an  infant  who 
spits  out  the  greater  part  of  a  teaspoonful  of  medicine 
will  take  it  very  well  if  given  a  little  at  a  time. 

Sometimes  a  child  continues  to  fight  so  hard  that  the 
exhaustion  following  seems  to  overbalance  all  the  good 
that  can  ensue.  Let  the  physician  be  informed  promptly 
of  the  state  of  the  case,  and  let  him  have  the  responsi- 
bility of  determining  what  course  it  is  best  to  pursue. 


250  THE    CARE    OE   THE   BABY. 

In  all  giving  of  medicine  there  must  be  the  strictest  ad- 
herence to  truth,  and  no  child  must  ever  be  told  that  a 
disasfreeable  dose  "tastes  orood."  If  this  course  is  not 
followed  the  one  dose  is  all  that  it  will  ever  take.  It  will 
feel,  too,  that  it  has  been  imposed  upon,  and  will  distrust 
the  nurse.  The  dose  of  medicine  should  always  be  made 
ready  out  of  the  child's  sight.  This  does  not  give  it  time 
to  think  over  the  matter,  and  to  determine  to  resist.  In 
the  case  of  children  who  lie  stupid  or  semi-delirious  in 
bed,  and  to  whom  the  administration  of  medicine  in  the 
ordinary  way  is  difficult  or  impossible,  much  can  some- 
times be  accomplished  by  the  use  of  the  medicine-drop- 
per. If  this  be  inserted  beside  the  teeth  and  emptied,  the 
contents  will  usually  be  swallowed.  The  dropper  should 
not  be  placed  between  the  teeth,  on  account  of  the  danger 
of  its  being  bitten.  Sometimes  the  child  may  be  laid  on 
its  side  and  the  medicine  emptied  from  a  spoon  into  the 
hollow  of  the  cheek. 

Many  liquid  medicines  will  be  of  a  disagreeable  taste 
no  matter  how  great  care  the  physician  may  take  in  pre- 
scribing or  the  druggist  in  preparing.  The  bad  taste 
may  be  avoided  to  some  extent  by  letting  the  child  take 
a  sip  of  milk  or  water,  a  mint  drop,  or  a  suck  at  an 
orange  immediately  before  and  after  swallowing.  It  is 
to  be  remembered  that  nearly  all  medicines  may  be  diluted 
with  a  little  water,  and  that  usually  a  little  sugar  may  be 
added.  This  will  make  the  task  much  less  unpleasant. 
The  physician  generally  intends  the  dose  to  be  diluted  in 
this  way  even  though  it  may  not  be  written  on  the  label. 
Thus  a  baby  may  choke  over  soda  mint  or  a  niter  mixt- 
ure if  undiluted,  but  really  likes  it  if  water  is  added. 
Yet  with  some  children  the  water  added  to  a  disagreeable 
medicine  is  a  disadvantage,  for  it  only  makes  the  dose  to 
be  taken  bigger,  and  the  difficulty  greater.    Castor  oil  may 


THE   SICK  BABY.  25  I 

be  floated  on  soda-water,  ice-water,  whiskey  and  water,  or 
lemon-juice.  In  this  way  it  often  tastes  very  little.  It  is 
also  nearly  tasteless  if  stirred  in  hot  milk,  but  the  child 
must  not  be  deceived  as  to  the  nature  of  the  drink,  or  it 
may  turn  against  plain  milk.  Cod-liver  oil  is  not  disa- 
greeable to  most  children,  many  of  them  even  learning 
to  like  it,  especially  if  given  in  the  form  of  an  emulsion. 
All  unmixed  oils  should  be  given  from  a  spoon  previously 
heated  in  hot  water,  in  order  to  make  them  less  thick. 
Bottles  containing  oily  medicines  should  have  the  mouths 
always  very  clean,  and  be  kept  in  a  cool  place  to  prevent 
the  contents  becoming  rancid.  After  taking  any  acid 
medicine  it  is  a  good  plan  for  the  child  to  rinse  its  mouth 
with  a  solution  of  baking-soda  in  water.  This  will  pre- 
vent the  teeth  being  set  on  edge  or  injured.  Small  and 
comparatively  tasteless  powders  can  best  be  placed  directly 
upon  the  tongue  and  a  sip  of  water  then  given  to  wash 
them  down.  Sometimes  they  may  be  mixed  with  a  little 
sugar  and  taken  in  the  same  way.  If  larger,  they  can  be 
stirred  up  thoroughly  in  a  little  jam  or  scraped  apple, 
provided  there  is  no  disease  of  digestion  which  makes 
this  inadvisable.  Another  good  plan,  where  sugar  is  per- 
mitted, is  to  put  a  small  quantity  of  this  in  a  teaspoon, 
empty  the  powder  upon  it  in  an  even  layer,  and  fill  up 
the  spoon  with  sugar.  The  whole  is  then  moistened  with 
water  and  swallowed.  Tasteless  powders  may  frequently 
be  given  in  bread  and  milk  or  milk  toast  without  the 
child  perceiving  them  in  the  slightest. 

Very  young  children  cannot  take  pills.  Later  they 
learn  easily,  particularly  if  the  pills  be  placed  within  a 
little  jelly  or  preserved  fruit.  It  is  sometimes  a  good 
plan  to  let  the  child  practise  with  home-made  bread  pills 
until  it  learns  how  to  swallow  them  easil5^  In  giving 
liquid  medicines  it  is  important  that  all  doses  be  meas- 


252  THE    CARE    OF  THE  BABY. 

ured  accurately.  Teaspoons  vary  greatly  in  size,  and, 
besides,  we  cannot  determine  jnst  when  the}-  are  exactly 
full.  The  little  glasses  marked  with  "teaspoon"  and 
"tablespoon,"  to  be  had  at  any  drug-store,  are  much  to 
be  preferred.  As  even  these  are  not  accurate,  the  best 
plan  is  to  procure  a  four-ounce  graduate,  such  as  is  used 
by  druggists,  marked  with  drachms  and  ounces  (Fig.  89, 
p.  417).  In  the  Appendix  (113-115)  will  be  found  a  table 
of  equivalents  showing  the  relative  value  of  tablespoon- 
fuls  and  teaspoonfuls,  ounces  and  drachms,  and  so  on,  a 
table  of  dosag-e  for  different  as^es,  and  a  dose-list  of  some 
of  the  medicines  most  frequently  given  to  children.  The 
proper  doses  of  the  various  remedies  which  may  be  re- 
ferred to  under  the  different  diseases  will  be  found  in  this 
last  table.  The  frequency  of  the  dosing  is  not  given,  as 
this  can  be  determined  only  by  the  physician.  It  must 
not  be  forgotten  that  the  drops  of  all  alcoholic  fluids  are 
much  smaller  than  those  of  water  (Appendix,  113). 

Feeding  a  sick  child  is  even  more  important  than 
giving  medicine,  and  often  just  as  difficult.  Where  there 
is  great  loss  of  appetite  it  is  important  to  remember  that 
the  child  will  sometimes  drink  all  of  a  small  glass  of 
milk  when  it  will  take  much  less,  or  none,  of  a  more 
formidable-looking  larger  one.  A  pinch  of  salt  in  boiled 
milk  helps  to  take  away  its  disagreeable  taste — but  it 
should  be  only  a  pinch.  Under  many  conditions  a  little 
sugar  may  be  added.  Many  children  like  the  addition  to 
the  milk  of  a  little  cocoa  or  extract  of  vanilla.  Some- 
times a  sick  child  can  be  persuaded  to  drink  milk  or  to 
take  other  food  if  the  nurse  will  take  some  also.  Some- 
times milk  may  be  given  in  place  of  water  when  the  child 
asks  for  a  drink.  When  there  is  little  desire  for  food 
every  effort  should  be  made  to  make  the  meal  appetizing. 
As  far  as  possible  a  child  should  not  hear  the  matter  of 


THE  SICK  BABY.  253 

his  food  discussed  before  him.  Often  it  is  better  not  to 
consult  him  in  advance  as  to  what  he  wants.  In  other 
cases  some  happy  suggestion  may  awaken  a  desire  for  a 
certain  article  of  food.  In  unconscious  or  delirious  con- 
ditions food  may  be  given  from  a  medicine-dropper  or  a 
spoon  in  the  way  described  for  giving  medicine  under 
these  circumstances  (p.  249).  Various  other  expedients 
dependent  upon  the  individual  case  will  suggest  them- 
selves to  an  intelligent,  wide-awake  nurse. 

Three  good  rules  are  to  be  borne  in  mind  in  this  connec- 
tion: First,  never  make  any  experiment  with  new  articles 
of  food  in  the  case  of  children  suffering  from  diseases  of 
the  stomach  or  bowels  or  in  typhoid  fever;  second,  at  the 
outset  of  any  illness  give  little  or  no  nourishment;  third, 
if  vomiting  occurs  whenever  food  is  given  in  the  course 
of  any  affection,  stop  all  feeding  until  the  doctor  can  be 
consulted.  A  number  of  prepared  foods  often  useful  in 
sickness  will  be  found  in  the  Appendix  (Dietary). 

An  absurd  and  still  too  widespread  idea  is  that  a  sick 
person  must  receive  a  limited  amount  of  water.  As  a 
rule,  and  particularly  in  fevers,  all  the  water  that  a  child 
asks  for  may  be  given  it,  provided  this  does  not  take  the 
place  of  nourishment.  Often  the  promise  of  water  as  a 
reward  will  induce  the  taking  of  some  food.  Where  for 
any  reason  the  amount  of  water  must  be  restricted,  it 
will  be  found  that  a  child  will  often  be  content  with  a 
small  glass  provided  it  is  allowed  to  drain  it,  while  it 
would  have  clamored  for  more  if  permitted  to  empty  a 
large  glass  only  partially. 

Quiet  in  the  room  is  very  greatly  to  be  desired,  and 
is  often  wofully  neglected.  Babies  cannot,  and  children 
of  three  or  four  years,  or  even  older,  do  not,  ask  for  it, 
since  they  do  not  realize  that  their  headaches  and  nervous- 
ness are  the  result  of  noise.     Visits  bv  friends  should  be 


254  THE    CARE    OF   THE   BABY. 

forbidden.  A  sick  child  should  be  encouraged  to  lie  in  its 
bed  as  much  as  possible,  although  there  are  some  excep- 
tions to  this.  Thus,  for  instance,  when  a  little  patient  has 
some  disease  attended  by  difficulty  in  breathing,  it  is 
usually  much  more  comfortable  if  allowed  to  sit  in  its  crib, 
or  even  if  carried  in  the  nurse's  arms  with  its  head  over 
her  shoulder.  A  weak,  exhausted  child,  or  one  with  fluid 
in  the  chest,  should  never  be  raised  rapidly  to  a  sitting 
position  in  the  bed  ;  indeed,  all  movement  is  to  be 
avoided  as  far  as  possible,  as  it  is  exhausting  and  danger- 
ous. A  nurse  about  to  move  a  child  with  an  injured 
limb  should  always  support  the  member  well  and  keep  it 
on  the  side  away  from  her.  A  child  with  hip7Joint  dis- 
ease or  with  disease  of  the  spine  should  be  lifted  hori- 
zontally, in  order  to  keep  the  weight  of  the  body  from 
pressing  on  the  sensitive  part.  The  position  of  the 
sick  child  in  bed  is  of  great  importance  in  pneumonia 
or  in  any  disease  attended  by  exhaustion.  It  should 
be  changed  frequently  from  the  back  to  one  side  or  the 
other,  to  prevent  the  blood  from  settling  in  any  one  part 
of  the  lung  and  to  hinder,  too,  the  formation  of  bed-sores. 
Many  people  seem  to  have  an  irresistible  desire  to 
cover  children  very  warmly  in  bed,  no  matter  how  much 
fever  they  may  have  or  how  hot  the  weather  may  be. 
This  is,  of  course,  all  wrong.  The  covers  should  be  light 
in  such  conditions,  and  a  child  sufficiently  old  should  be 
asked  whether  it  is  too  warm.  A  feverish  baby  should 
never  be  held  long  on  the  lap  in  hot  weather.  On  the 
other  hand,  whenever  a  child  is  taken  up,  though  only 
for  a  moment,  it  should  have  a  wrap  thrown  about  it. 
We  often  forget,  too,  that  when  well  enough  to  be 
propped  in  bed  its  arms  and  chest  are  often  more  lightly 
clothed  than  when  it  is  completely  dressed.  It  is  folly  to 
put  a  child  to  bed  for  a  bronchitis  and  not  to  guard  it. 


THE   SICK  BABY.  255 

by  having  it  wear  a  light  sack,  against  the  danger  of 
taking  cold.  There  should  be  a  bed-dress  for  the  night 
and  another  for  the  day  (see  page  115). 

Cleanliness  of  the  body  is  very  necessary  in  sickness. 
As  a  rule,  the  child  should  be  sponged  all  over  once  or 
twice  a  day  with  soap  and  water  or  sometimes  with  water 
and  alcohol,  either  cool  or  warm  according  to  circum- 
stances. In  cases  of  diarrhoea  careful  local  washing 
should  follow  each  evacuation  of  the  bowels.  Starch- 
water  (Appendix,  47)  is  preferable  to  ordinary  water  for 
this  purpose,  and  the  application  of  a  dusting  powder 
completes  the  drying.  The  warm  tub-bath  can  be  used 
in  many  diseases.  In  the  eruptive  fevers,  however, 
neither  this  nor  sponging  should  be  employed  without 
medical  advice,  since  some  physicians  are  much  opposed 
to  them  in  diseases  accompanied  by  a  rash.  In  eczema, 
too,  the  application  of  water  sometimes  does  harm.  It  is 
much  better  at  the  beginning  of  any  illness  to  obtain  ex- 
plicit directions  regarding  bathing. 

Cleanliness  of  the  mouth  must  be  carefully  attended  to 
during  sickness,  especially  if  the  mucous  membrane  is 
inflamed,  since  the  decomposition  which  goes  on  may 
readily  injure  the  teeth.  The  nurse  must  wash  the  mouth 
with  an  antiseptic  solution  (Appendix,  75)  frequently  dur- 
ing the  day,  or  with  a  little  magnesia  mixed  with  water. 

The  bed  for  the  sick  child  should  be  comfortable  and 
clean.  The  sheets  should  be  changed  often,  and  the  fresh 
ones  always  warmed  before  they  are  used.  In  cases  of 
prolonged  illness  it  is  a  good  plan,  although  not  often 
practised,  to  have  two  beds,  one  for  the  day  and  one  for 
the  night.  This  gives  an  opportunity  for  airing  the  beds, 
and  the  change  is  distinctly  restful  to  the  patient.  A 
draw-sheet  or  pad  of  some  sort  is  of  service  where  there 
is  any  tendency  to  soiling  of  the  bed. 


256  THE    CARE    OF   THE   BABY. 

After  an  offensive  movement  from  the  bowels  fresh  air 
is  needed  in  the  room  as  soon  as  possible.  As  the  throw- 
ing open  of  the  windows  is  often  impracticable,  an  aro- 
matic fumigating  pastille  or  some  coffee  may  be  burned. 
This  procedure,  of  course,  does  not  purify  the  air  in  the 
slio-htest,  but  it  does  serve  to  conceal  to  some  extent 
the  disagreeable  odor  until  ventilation  can  remove  it 
entirely. 

The  method  of  nursing  infectious  diseases  and  of  disin- 
fecting the  room  has  already  been  described  when  treat- 
ing of  the  Trained  Nurse  and  of  the  Sick-room  in 
Chapters  IX.   and  X. 

Various  methods  for  the  external  treatment  of  a  sick 
child  are  often  ordered  by  the  physician.  Baths  are  used 
for  this  purpose  as  well  as  for  cleanliness.  The  baths 
may  be  general  or  local,  hot  or  cold,  applied  in  the  form 
of  sponge-baths,  tub-baths,  wet  packs,  and  other  methods, 
and  medicated  in  various  ways.  Further  details  of  these 
procedures  and  of  their  value  in  disease  will  be  found 
under  the  heading  of  Baths  in  the  Appendix  ("39-54). 

Physicians  often  order  dry  heat  or  moist  heat  to  be 
used  locally.  The  former  is  applied  in  the  shape  of 
hot  bottles,  bags  of  hot  water,  sand,  or  salt,  hot  bricks, 
or  a  hot  stove-lid.  It  is  useful  where  the  circulation  is 
poor  and  the  temperature  of  the  body  is  lower  than  it 
should  be.  The  hot  articles  should  be  wrapped  carefully 
in  flannel  to  prevent  burning  the  skin.  This  is  especially 
important  when  the  child  is  unconscious  and  cannot 
complain,  since  serious  burns  have  often  been  produced 
by  carelessness  in  this  respect.  Moist  heat  is  of  value 
to  relieve  pain  and  inflammation.  It  may  be  used  in  the 
form  of  fomentations  or  of  poultices  of  different  kinds 
(Appendix,  54-66).  The  former  are  lighter,  but  the 
latter  retain  their  heat  longer. 


THE   SICK  BABY.  257 

Cold  is  applied  locally,  in  the  form  either  of  cold  com- 
presses (Appendix,  54)  or  of  ice-bags,  in  order  to  subdue 
inflammation  or  pain.  Ice-bags  are  made  of  thin  rubber, 
and  are  of  different  sizes  and  forms.  The  thinner  the 
rubber  the  more  easily  does  the  bag  adapt  itself  to  the 
shape  of  the  part  and  the  more  successfully  keep  it  cool. 
Many  of  the  ice-bags  sold  in  the  shops  are  entirely  too 
thick  and  are  practically  useless.  A  pig's  bladder  filled 
with  ice  forms  an  excellent  substitute  for  the  rubber  bag. 
The  bag  should  be  not  more  than  half  filled  with  small 
fragments  of  ice.  If  it  is  too  full,  it  is  impossible  to 
apply  it  accurately.  Since  the  moisture  of  the  surround- 
ing air  condenses  on  the  bag,  dry  towels  must  be  so 
placed  that  the  drip  will  not  wet  the  child.  A  piece 
of  thin  cloth  must  sometimes  be  placed  between  the  ice- 
bag  and  the  skin  to  prevent  the  latter  from  being  frozen, 
but  ordinarily  this  is  not  needed,  and  checks  the  action 
of  the  cold  too  greatly.  Young  infants  do  not  bear  the 
application  of  cold  in  any  form  at  all  well. 

The  nurse  will  often  be  required  to  make  other  appli- 
cations, such  as  mustard  plasters,  turpentine  stupes,  spice 
plasters,  and  the  like  (Appendix,  67-70).     She  will  some- 


FlG.  64. — Infant's  syringe. 

times  need,  too,  to  administer  enemata  for  constipation 
or  for  inflammation  of  the  bowel  and  diarrhoea,  or  per- 
haps even  to  give  nourishment  in  this  way.  A  hard- 
rubber  syringe  holding  four  to  six  ounces  and  fitted 
with  a  piston  which  moves  very  easily  is  well  suited  for 
ordinary  use.     Another  form  useful  for  small  injections, 

17 


258  THE   CARE    OF   THE   BABY. 

called  the  "infant's  syringe,"  consists  of  a  soft-rubber 
bulb  with  a  hard-rubber  nozzle  (Fig.   64). 

In  using  a  syringe  the  fluid  should  be  drawn  into  it, 
the  nozzle  then  well  greased  with  vaseline  and  inserted, 
and  the  contents  expelled  very  slowly.  For  giving  large 
injections,  as  in  inflammation  of  the  bowel  and  constipa- 
tion, the  ordinary  elastic  bulb  syringe  (Fig.  65)  or,  much 
better,  a  fountain  syringe  (Fig.  3,  p.  30)  is  sometimes  to 
be  preferred.     A  long  rubber  tube  with  a  funnel  at  one 


Fig.  65. — Elastic  bulb  syringe. 

end  and  a  hard-rubber  nozzle  at  the  other  makes  an  excel- 
lent extemporaneous  fountain  syringe.  As  it  is  sometimes 
difficult  to  get  a  child  to  retain  an  injection,  it  is  a  good 
plan  to  wrap  a  narrow  roller  bandage  firmly  around  the 
nozzle  (Fig,  66).  The  pressure  of  the  bandage  against 
the  opening  of  the  bowel  helps  to  prevent  the  fluid  from 
being  ejected.  Large  injections  should  be  given  very 
slowly,  with  the  child  upon  its  back  or  its  left  side. 

It  is  often  necessary  in  some  cases  of  obstinate  vomiting 
or  where  there  is  refusal  to  take  sufficient  food,  to  feed  a 
child  by  the  use  of  a  small  stomach-tube  passed  into  the 
stomach  through  the  mouth.  This  procedure,  called 
"gavage,"  is  neither  as  unpleasant  nor  as  difficult  as  it 
appears.  It  requires,  however,  some  special  training  to 
do  it  properly. 


THE   SICK  BABY.  259 

It  is  often  necessary  for  the  nurse  to  make  applications 
to  the  throat.  This  is  best  clone  with  a  large,  straight 
camel' s-hair  brush  firmly  fastened  to  a  straight,  stout 


Fig.  66. — Hard-rubber  syringe  with  roller  bandage  on  the  nozzle. 

stick.  The  bent  brushes  or  those  mounted  on  wire 
handles  are  not  nearly  so  easily  controlled.  Physicians 
often  use  cotton  wrapped  on  a  metal  applicator.  If  the 
child  is  well  trained  and  of  sufficient  age,  it  is  simply 
necessary  to  depress  the  tongue  with  a  spoon  while  mak- 
ing the  application.  In  younger  children  the  procedure 
is  often  one  of  a  good  deal  of  difficulty,  and  two  persons 
are  required  to  accomplish  it  satisfactorily.  The  helper 
holds  the  child  facing  a  bright  light,  and  wrapped  in  a 
shawl  which  keeps  its  arms  and  hands  close  to  its  sides. 
The  nurse  now  takes  her  position  opposite  it,  with  a  tea- 
spoon in  the  left  hand  and  a  brush  already  prepared  in 
the  other.  Watching  her  opportunity,  she  carefully  in- 
serts the  handle  of  the  spoon  between  the  teeth  and 
gradually  and  gently  works  it  inward.  As  it  reaches  the 
back  of  the  tongue  the  child  o-ao-s  and  at  the  same  time 
involuntarily  opens  its  mouth  widely.  This  is  the  mo- 
ment for  the  rapid  yet  thorough  painting  of  the  throat. 

Spraying  of  the  throat  is  done  with  an  atomizer  (Fig. 
67).  When  employing  this  apparatus  it  is  important  to 
see  that  the  tongue  is  well  depressed,  as  otherwise  most 
of  the  solution  lights  upon  it  instead  of  where  needed. 

The  method  of  observing  pulse,  temperature,  and  res- 
piration has  already  been  considered  in  Chapter  II. 

Something  may  be  said  here  regarding  the  manner  in 
which  the  nurse  should  prepare  the  child  for  the  doctor's 


260  THE    CAKE    OE   THE   BABY. 

examination.  The  clothes  should  be  removed  to  a  large 
extent.  Certainly  no  starched  garments  should  be  left 
over  the  child's  chest  if  an  examination  of  this  is  to  be 
made.     It    is   impossible    to   hear    anything    accurately 


Bulb  atomizer. 


through  these.  Everything  should  be  arranged  in  ad- 
vance to  facilitate  a  rapid,  although  gentle  and  easy  and 
not  hurried,  undressing  of  the  patient.  Preferably  the 
child  should  be  in  bed  and  dressed  in  its  night-clothes 
only.  A  thin  clean  towel  should  be  at  hand  which  the 
physician  may  use  to  put  over  the  chest,  if  he  wishes  it, 
after  the  night-clothes  are  loosened  and  slipped  down  or 
off.  The  nurse  must  see,  too,  that  abundant  light  can 
enter  the  room,  as  any  examination  is  unsatisfactory  with- 
out this.  If  the  physician  wishes  to  examine  the  back 
of  the  child,  the  child  may  be  seated  in  bed,  or,  if  an  in- 
fant, lifted  over  the  nurse's  shoulder.  When  it  is  very 
weak  it  may  be  rolled  upon  its  stomach  with  the  face 
turned  to  one  side  to  give  it  full  opportunity  to  breathe. 
When  the  throat  is  to  be  examined  the  nurse  must  see 
that  there  is  abundant  light  from  the  nearest  window. 
She  should  support  the  child  in  bed  or  in  her  lap,  keeping 
its  hands  and  feet  well  imprisoned,  and  letting  the  back 
of  its  head  lean  against  her  breast,  on  the  side  nearest  to 
that  on  which  the  physician  is  standing.  Holding  it  on 
the  other  side  makes  an  examination  verv  inconvenient. 


THE   SICK  BABY.  26 1 

A  few  words  only  can  be  devoted  here  to  the  diet  to  be 
followed  in  sickness.  As  has  already  been  intimated  it 
may  be  accepted  as  an  axiom  that  every  child  suddenly 
taken  ill  is  better,  for  some  time  at  least,  without  food. 
This  is  particularly  true  of  infants  attacked  by  severe 
acute  vomiting  and  diarrhoea.  There  is  absolutely  noth- 
ing- to  be  gained  by  putting  into  a  baby's  stomach  food 
which  will  simply  serve  to  keep  up  the  irritation  present 
there  or  in  the  intestines.  Certainly  all  milk  should  be 
stopped  for  twenty-four  hours,  and  the  baby  be  fed  on 
barley-water  (Appendix,  i)  or  albumen-water  (Appendix, 
3).  Loss  of  appetite  with  a  coated  tongue  occurring 
in  a  child  of  any  age  is  not  always  a  sign  that  a  tonic 
or  digestant  is  needed.  It  is  often  but  a  prayer  on 
the  part  of  the.  stomach  to  be  given  a  period  of  rest. 
Should  a  feverish  condition  last  some  days,  the  diet 
should  continue  to  be  of  the  lightest.  It  is  often  one  of 
the  most  difficult  things  imaginable  to  find  out  what 
kind  of  food  will  best  agree  with  infants  sujBfering  from 
chronic  indigestion  or  chronic  diarrhoea.  A  sincere  pity 
for  the  little  patients  compels  me  to  urge  most  strongly 
that  the  mother  make  no  experiments  in  such  a  case. 
Immeasurable  harm  to  numberless  babies  has  followed 
just  such  experimentation.  The  experienced  physician, 
with  his  best  endeavors,  often  finds  the  discovery  of  the 
proper  food  a  herculean  task.  The  various  recipes  for 
different  articles  of  diet  that  will  be  found  in  the 
Appendix  are  intended,  not  to  constitute  a  list  from 
which  the  mother  shall  select  at  her  own  discretion,  but 
to  be  a  guide  in  the  preparation  of  the  food  which  the 
child's  physician  may  direct. 

A  well-trained  nurse  keeps  a  careful  daily  record  of 
everything  which  has  taken  place  relative  to  the  child. 
Thus  a  portion  of  such  a  record  would  perhaps  read  as 
follows : 


262 


THE    CARE    OE  THE  BABY. 


June  23,  1902. 
8  a.m.  Temperature,  102.6°;  pulse,  140;  respiration,  35.    Took 
6  ounces  of  milk  and  2  ounces  of  lime-water.     Cough 
medicine  and  pill  given.     A  teaspoonful  of  whiskey. 

10  A.  M.     Bowels  opened,  natural  in  appearance. 

11  A.  M.  Took  only  3  ounces  of  milk  and  i  ounce  of  lime-water. 

INIedicine  and  whiskey  given.     Temperature,  103°. 
12.30  p.  M.  Very  restless  and  nervous.     Temperature,  105°.    Has 
coughed  a  great  deal.     Sponged  with  cool  water. 

1  p.  M.  Temperature,  101.2°.     Quiet;  looks  better. 

2  p.  M.  Has  slept  for  an  hour.     Temperature,  102°  ;  pulse,  132  ; 

respiration,  34.     Cough  medicine  and  pill  given.     A  tea- 
spoonful  of  whiskej'  and  4  ounces  of  beef  tea. 

Such  a  record  as  this  is  of  the  greatest  assistance  to  the 
doctor,  and  tells  him  of  the  progress  of  the  case  better 
than  any  answers  to  questions  could  possibly  do. 

A  still  better  and  more  quickly-read  arrangement,  kept 
on  paper  of  a  suitable  size,  would  be  as  follows  : 


3 
0 

■3 

Medicines. 

Food. 

Stimulants. 

Remarks. 

6.23 
'02. 

8  a.m. 

102.6 

140 

35 

I  teaspoonful 
cough  mix- 
ture and  I 
pill. 

60Z.  milk  and 
2  oz.  lime- 
water. 

I  teaspoon- 
ful     whis- 
key. 

10 

Bowels  opened  ;  nat- 
ural in  appear- 
ance. 

II 

103 

I  teaspoonful 
cough  mix- 
ture. 

3  oz.  milk  and 
I  oz.  lime- 
water. 

I  teaspoon- 
ful    whis- 
key. 

12.30 

P.M. 

los 

Very  restless  and 
nervous.  Coughed 
a  great  deal. 
Sponged  with  cool 
water. 

I 

101.2 

!  Quiet ;  looks  better. 

2 

102 

132 

34 

I  teaspoonful     4  oz.  beef  tea. 
cough  mix- 
ture and  I 
pill. 

I  teaspoon-i  Has    slept    for    an 
ful     whis-(      hour, 
key. 

As  a  rule,  nurses  keep  the  record  of  the  pulse,  tem- 
perature, and  respiration  on  a  special  chart  provided  for 


THE   SICK  BABY.  263 

the  purpose.  There  are  various  charts  of  this  sort,  of 
different  patterns,  to  be  had  from  medical  publishers. 
The  author  ventures  to  recommend  the  "Graphic  Clin- 
ical Chart"  designed  by  himself. 

III.  The  Disorders  of  Childhood. 

Under  this  heading  may  be  considered  briefly  a  few  of 
the  commoner  diseases,  habits,  and  accidents  of  children, 
with  such  treatment  as  the  mother  is  justified  in  using. 
They  are  classified  to  some  extent  as  a  matter  of  conve- 
nience, but  the  divisions  are  not  sharply  defined,  and 
some  disorders  which  have  been  placed  in  one  class 
might  with  equal  or  greater  propriety  have  been  consid- 
ered in  some  other.  Lack  of  space  has  made  the  descrip- 
tions necessarily  concise. 

(l)   DISEASES  OF  THE   DIGESTIVE  APPARATUS. 

Hare-lip. — A  complete  cleft  through  one  or  both  sides 
of  the  upper  lip,  exposing  the  teeth  and  even  extending 
into  the  nose.  It  sometimes  interferes  with  sucking,  and 
requires  a  specially-prepared  rubber  nipple,  or  makes 
feeding  from  a  spoon  necessary.  It  should  be  operated 
upon  in  the  early  weeks  of  life.  The  success  of  the  opera- 
tion is  often  very  remarkable. 

Cleft  Palate. — A  fissure  through  the  palate,  forming 
one  cavity  of  the  mouth  and  nose.  It  is  very  often  com- 
bined with  hare-lip.  It  not  only  greatly  interferes  with 
talking  later  in  life,  but  in  infancy  renders  nursing  im- 
possible by  taking  away  the  power  of  suction.  In  such 
a  case  the  child  must  be  fed  with  the  mother's  milk  from 
a  spoon  or  from  a  feeding-cup  with  a  spout  to  it,  to  which 
a  rather   long   nipple  with   large  openings  is  attached. 


264  THE   CARE    OF  THE   BABY. 

The  milk  thus  flows  into  the  mouth  by  gravity,  without 
the  need  of  sucking.  A  special  apparatus  has  been  de- 
vised, consisting-  of  an  ordinary  nipple  to  the  upper  sur- 
face of  which  is  attached  a  flap  of  thin  rubber,  made  to 
act  as  a  false  palate  and  to  close  the  unnatural  opening 
during  nursing.  Operation  is  better  deferred  until  the 
child  is  two  or  more  years  old. 

Tongue-tie. — In  this  condition  the  little  membrane  on 
the  under  surface  of  the  tongue  is  too  tight  or  is  attached 
too  far  forward  and  holds  the  tongue  down.  It  is  much 
more  uncommon  than  is  ordinarily  supposed.  If  the 
child  can  suck  well  and  can  protrude  its  tongue  at  all, 
there  is  no  tongue-tie  of  any  account.  The  operation  for 
the  affection  is  simple  and  painless. 

Inflammation  of  tine  Mouth. — PvcatarrJial  inflamma- 
tion may  occur  during  fever,  or  from  indigestion  or  lack 
of  cleanliness.  The  mouth  is  hot  and  tender,  and  nursing 
is  painful,  the  nipple  being  dropped  with  a  cry.  The 
lining  of  the  gums,  cheeks,  and  palate  is  much  reddened, 
and  is  either  dryer  than  natural  or  very  moist  from  a  pro- 
fuse secretion  of  saliva. 

In  aphthous  inflammation  little  shallow  ulcers  {aphthcs) 
form  over  the  tongue,  palate,  and  inside  lining  of  the 
lips  and  cheeks. 

The  treatment  for  either  of  these  conditions  consists 
in  the  administration  of  a  mild  purgative,  such  as  castor 
oil  or  magnesia,  and  the  frequent  application  of  a  mouth- 
wash (Appendix,  84). 

There  is  a  much  more  extensive  and  serious  ulcerous 
inflammation,  and  another  still  worse,  the  gangrenous 
form,  which  must  at  once  be  referred  to  a  physician;  as, 
indeed,  the  simpler  forms  must  be  if  they  do  not  heal 
immediately. 


THE   SICK  BABY.  265 

Thrush. — A  disease  of  the  mouth  far  commonest  in 
bottle-fed  or  sickly  children  in  the  early  weeks  of  life. 
Small  whitish  patches,  sometimes  crowded  thickly  to- 
gether, form  over  the  lining  of  the  mouth,  and  especially 
on  the  tongue,  cheeks,  and  hard  palate.  They  greatly 
resemble  curdled  milk,  but  differ  in  that  they  can  be  re- 
moved only  by  the  use  of  considerable  force.  A  lack  of 
perfect  cleanliness  about  the  mouth  and  the  bottles  and 
rubber  nipples,  and  the  use  of  bottles  with  long  rubber 
tubes,  are  active  factors  in  producing  the  disease.  It  is 
very  commonly  associated  with  some  disturbance  of 
digestion,  and  it  is  distinctly  contagious.  The  symptoms 
are  an  indisposition  to  nurse  on  account  of  the  pain  pro- 
duced, often  combined  with  colic  and  some  diarrhoea  and 
vomiting. 

Treatment  consists  in  the  greatest  cleanliness  in  every- 
thing about  the  food.  The  mouth  should  be  washed  very 
carefully  every  two  or  three  hours  with  a  solution  of  boric 
acid  (Appendix,  79)  applied  on  a  soft  cloth  or  on  absorb- 
ent cotton,  or  the  mouth  painted  with  a  little  borax  and 
glycerin  (Appendix,  84).  As  the  disease  is  sometimes 
fatal  in  delicate  children,  the  advice  of  a  physician  should 
be  obtained. 

Disordered  Dentition. — It  has  already  been  stated  that 
the  cutting  of  the  teeth  is  not,  as  a  rule,  responsible  for 
any  of  the  ailments  so  commonly  attributed  to  the  pro- 
cess', and  that  redness  of  and  irritation  of  the  gums  are 
not  necessary  parts  of  it.  It  is,  however,  true  that  some 
babies  are  peculiarly  susceptible  to  even  slight  disturb- 
ances in  the  mouth,  and  that  we  occasionally  find  attend- 
ing the  eruption  of  the  teeth  various  symptoms  which 
apparently  can  be  accounted  for  in  no  other  way.  At 
times  a  certain  amount  of  catarrhal  inflammation  of  the 


266  THE    CARE    OE   THE   BABY. 

gums  is  present,  shown  by  increased  heat  with  some  red- 
ness and  by  a  disposition  to  bite  vigorously  upon  anything 
placed  in  the  mouth. 

Slight  diarrhoea,  loss  of  appetite,  feverishness,  bron- 
chitis, some  eruption  of  the  skin,  and,  especially,  great 
restlessness,  irritability,  or  other  nervous  symptoms,  may 
appear  shortly  before  a  tooth  is  cut,  and  disappear  with 
astonishing  rapidity  as  soon  as  it  is  through  the  gum. 
Remarkable  improvement  will  sometimes  follow  within 
a  few  hours  the  lancing  of  the  gum  over  an  approaching 
tooth.  Nevertheless,  it  is  only  rarely  that  lancing  is 
really  necessary.  The  important  point  is  that  disordered 
dentition  is  the  great  exception  and  not  the  rule,  and  that 
the  mother  must  never  assume  that  it  is  teething  which 
makes  her  baby  ill,  or  try  to  treat  this  symptom  or  let  it 
go  as  a  matter  of  no  consequence.  Almost  always  it  is 
something  else  than  dentition  which  is  producing  the 
symptoms. 

If  the  baby  enjoys  biting  on  a  soft-rubber  ring  or  hav- 
ing its  gums  gently  rubbed  with  the  finger,  there  is  no 
objection  to  this;  but  no  attempt  should  ever  be  made  to 
"  rub  the  tooth  through  "  with  the  finger-nail  or  a  thim- 
ble or  other  hard  substance,  as  this  is  often  the  cause  of 
inflammation  of  the  gums. 

Dentition  may  be  much  delayed,  or  the  teeth  may 
come  in  irregularly  or  decay  very  rapidly.  Early  decay 
of  the  teeth  or  the  completion  of  the  first  year  without  a 
tooth  makes  the  existence  of  rickets  seem  very  probable, 
although  prolonged  ill-health  from  other  causes  may  act 
similarly.  It  occasionally  happens  that  certain  of  the 
first  or  second  teeth  are  never  cut.  Occasionally  children 
are  born  with  an  incisor  tooth  already,'  cut  through. 

Gum-boil. — This  consists  of  an  abscess  at  the  root  of 


THE  SICK  BABY.  267 

a  diseased  tooth,  lasting  several  days  and  then  usually 
bursting.  It  often  makes  the  face  swell  badly.  Painting 
the  gum  with  tincture  of  iodine  or  applying  one  of  the 
little  toothache  plasters  to  be  bought  in  the  drug-stores 
may  prevent  the  abscess  from  forming.  Holding  warm 
water  in  the  mouth  or  the  application  of  a  warm-water 
bag  to  the  cheek  relieves  the  pain.  Lancing  the  abscess 
is  the  quickest  cure. 

Sore  Throat. — Infants  with  sore  throat  avoid  much 
nursing  and  swallow  with  a  gulp  and  a  cry.  Older  chil- 
dren will  frequently  complain  of  the  throat,  but  in  many 
cases  they  make  no  complaint  even  though  it  is  much 
inflamed.  On  this  account  the  mother  should  herself  ex- 
amine the  throat  of  any  child  who  is  taken  ill.  Fever  is 
generally  present,  and  the  speech  often  is  a  little  thick. 
The  throat  may  be  red  without  swelling  of  the  tonsils,  or 
the  tonsils  also  may  be  red  and  swollen,  and  perhaps  may 
exhibit  one  or  more  white  points.  It  is  needless  at  once 
to  become  greatly  alarmed  over  these  latter.  They  are 
common  and  usually  mean  nothing,  but  as  they  some- 
times indicate  beginning  diphtheria,  the  child  should 
be  isolated  at  once  and  a  physician  be  sent  for.  (See 
DipJithcria. ) 

A  child  with  sore  throat  should  be  confined  to  bed, 
given  a  laxative,  and  allowed  to  suck  pieces  of  ice  fre- 
quently and  to  use  an  astringent  gargle  (x\ppendix,  86). 
If  there  is  much  fever,  a  simple  fever  mixture  (Appen- 
dix, 108)  may  be  administered  until  the  physician  arrives. 
He  may  find  it  best  to  give  other  remedies  or  to  order 
the  throat  to  be  painted  internally.  The  danger  of  per- 
manent deafness  following  repeated  attacks  of  sore  throat 
must  never  be  forgotten. 


268  THE   CARE    OE  THE  BABY. 

Chronic  Enlargement  of  the  Tonsils ;  Adenoid 
Growths. — This  is  a  common  affection  in  children, 
beginning  in  early  infancy.  The  tonsils  are  pale  with- 
out sign  of  inflammation,  and  sometimes  are  so  large  that 
they  almost  touch.  Associated  with  this  enlargement  is 
nsually  an  overgrowth  of  certain  tissue  resembling  the 
tonsils  (adenoids),  situated  out  of  sight  high  up  in  the 
throat  at  the  back  of  the  nose,  and  it  is  this  overgrowth 
that  causes  the  chief  hinderance  to  breathing.  In  some 
cases  the  child  constanth'  breathes  with  its  mouth  open, 
and  often  snores  badly  at  night.  Its  speech  is  thick, 
affections  of  the  ears  are  frequent,  and  the  voice  has  a 
heavy,  stopped-up  sound,  much  like  that  of  a  person  with 
a  bad  cold  in  the  head.  Treatment  is  important,  for  the 
constant  difficult}"  in  getting  sufficient  air  is  apt  to  occa- 
sion bronchitis,  sore  throat,  and  heavy  breath,  and  to 
prodnce  impairment  of  development  and  of  the  general 
health,  and  even  to  make  the  child  chicken-breasted. 
Permanent  deafness  may  also  result. 

Chronic  Indigestion. — A  condition  marked  by  capri- 
ciousness  of  or  great  loss  of  appetite,  coated  and  often 
"  worm-eaten  "  tongue,  flushing  of  the  face  with  or  with- 
out fever,  pain  and  swelling  of  the  abdomen,  restlessness 
at  night,  slight  headache,  and  often  constipation  alter- 
nating with  slight  diarrhoea.  Mucus  is  very  apt  to 
appear  in  the  passages,  whether  these  are  loose  or 
hard.  The  disease  is  frequently  seen  in  later  childhood, 
and  is  a  very  obstinate  one.  In  the  line  of  treatment 
diet  is  of  prime  importance.  All  fats  and  sweets  must 
be  avoided,  and  the  amount  of  starchy  food  be  reduced 
very  much.  Milk,  lean  meats,  poultry,  eggs,  and  green 
vegetables  constitute  the  principal  articles  of  diet. 
Medicines   are    usually    required. 


THE   SICK  BABY.  269 

Vomiting. — The  fact  that  an  over- fed  baby  will  regur- 
gitate the  excess  of  iriilk  which  it  has  taken  has  already- 
been  alluded  to  (p.  120).  There  is  a  difference  between 
regurgitation  and  true  vomiting.  The  latter  is  accom- 
panied by  coldness,  pallor,  and  moisture  of  the  skin,  indi- 
cating nausea.  The  vomiting  may  be  a  single  effort  and 
may  bring  relief,  or  it  may  be  repeated  again  and  again 
until  the  patient's  state  is  alarming.  It  does  not  always 
indicate  a  disordered  stomach,  for  it  frequently  ushers  in 
some  acute  disease,  such  as  jDueumonia  or  scarlet  fever, 
and  it  is  repeated  and  very  obstinate  in  inflammation  of 
the  brain.  The  importance  is  manifest  of  having  a  phy- 
sician determine  the  cause  in  serious  cases.  The  first 
treatment  consists  in  the  immediate  and  absolute  stopping 
of  all  nourishment.  No  food  should  be  given  for  six  or 
more  hours,  and  after  that  only  small  amounts  of  barley- 
water  or  albumen-water  (Appendix,  2,  3).  Complete  rest 
is  essential,  and  trotting  on  the  knee,  raising  suddenly,  or 
other  quick  movements  must  be  avoided.  A  spice  plaster 
or  mustard  plaster  (Appendix,  68,  69)  may  be  placed  over 
the  position  of  the  stomach,  just  below  the  ribs  in  front, 
slightly  to  the  left  side.  Soda-mint  (Appendix,  105)  may 
be  given,  or  to  older  children  soda-mint  and  tincture  of 
ginger.  The  swallowing  of  pieces  of  ice  (not  allowing 
them  to  dissolve  in  the  mouth)  is  often  useful.  After 
the  attack  is  over  a  laxative,  such  as  magnesia,  may  be 
administered,  for  the  purpose  of  carrying  out  of  the 
intestines  any  irritating  substances  which  may  have 
entered  them. 

DiarrhcBal  Diseases. — These  are  oftenest  caused  by 
improper  food,  by  taking  cold,  or  by  very  hot  weather. 
They  are  exceedingly  common  in  bottle-fed  babies  in 
summer-time,  as  a  result  of  changes   produced    in    the 


270  THE    CARE    OF   THE   BABY. 

milk  by  the  o^erms,  the  growth  of  which  the  high 
temperature  so  greatly  fav^ors.  The  number  of  pas- 
sages varies  from  four  or  six  up  to  thirty,  forty,  or 
more  in  twenty-four  hours.  Their  character,  too,  is 
changed  from  the  normal.  They  may  be  greenish,  yel- 
lowish-green, whitish  from  the  presence  of  undigested 
milk,  clay-colored  from  absence  of  bile,  black,  brown,  or 
colorless;  semi-liquid  or  very  watery;  odorless  or  ex- 
cessively offensive;  small  in  size  or  so  large  that  we 
wonder  how  a  child's  bowel  could  have  held  so  much. 
Mucus  and  blood  may  be  present. 

In  simple  diarrhoea^  which  is  very  common  in  summer, 
the  passages  exhibit  some  one  of  the  colors  mentioned, 
there  is  little  if  any  fever,  and  vomiting  may  or  may  not 
occur. 

In  cholera  iiifantum  the  passages  are  very  numerous, 
are  entirely  watery  and  colorless,  and  there  is  constant, 
exhausting  vomiting  and  high  fever,  followed  at  last  by 
great  coldness.     It  is  a  comparatively  rare  disease. 

In  inJlammatio7i  of  the  intestine  (inflammatory  diar- 
rhoea; dysentery),  on  the  other  hand,  the  movements  are 
usually  small,  frequent,  liquid,  exhibit  color  of  some  sort, 
and  contain  mucus  and  often  streaks  of  blood.  Some- 
times the  movement  is  almost  entireh-  of  blood-stained 
mucus.  IModerate  fever  is  present,  and  vomiting  is  not  a 
prominent  symptom.  INIore  or  less  straining  usually 
occurs.  Many  of  the  cases  of  severe  summer  diarrhoea 
are  of  this  nature. 

An  infant  "falls  away"  with  astonishing  rapidity  in 
severe  diarrhoeal  disorders,  and  in  twenty-four  to  forty- 
eight  hours  may  become  shrivelled,  wrinkled,  and  cold. 
The  disease  is,  as  a  rule,  not  so  rapid  or  so  serious  after 
infancy  is  past,  but  even  then  it  is  very  weakening;  con- 
sequently  no   case   should   ever   be   allowed   to  run  on 


THE   SfCK  BABY.  27  I 

without  treatment.  A  mother,  if  she  cannot  possibly 
do  otherwise,  may  treat  slight  attacks  herself  for  not 
longer  than  twenty-four  hours,  but  after  this  must  delay 
no  longer  in  calling  in  a  physician.  She  should  be 
careful  to  save  the  passages  to  show  to  him. 

The  first  essential  of  treatment  is  to  stop  all  food,  since 
it  only  adds  fuel  to  the  fire.  A  baby  if  hungry  may  have 
a  little  barley-water  (Appendix,  i).  If  very  hot  it  may 
be  bathed  with  cool  water,  or  if  cold  may  have  a  mustard 
bath.  Absolute  rest  in  bed  is  very  desirable.  In  the 
beginning  of  the  attack  a  dose  of  castor  oil  may  be 
given  to  empty  the  bowel  of  anything  irritating  it.  Af- 
ter this  I  or  2  teaspoonfuls  of  a  chalk-and-bismuth  mix- 
ture (Appendix,  107)  may  be  given  every  couple  of  hours. 
Bismuth  colors  the  passages  black,  and  no  alarm  need  be 
felt  at  the  presence  of  this  color.  The  mother  should 
never  give  paregoric,  laudanum,  or  other  preparation  of 
opium  to  a  child  suffering  from  diarrhoea  or  any  other 
disease.     It  is  an  invaluable  but  a  dangerous  medicine. 

Some  healthy-looking  but  over-fed  babies,  instead  of 
regurgitating,  constantly  void  undigested  milk  in  the 
stools  and  have  too  frequent  passages.  The  amount  of 
food  should  be  reduced  or  its  character  altered.  Insuf- 
ficient clothing  is  a  cause  of  repeated  attacks  of  diar- 
rhoea. A  careful  covering  of  the  abdomen,  arms,  and 
legs  with  close-fitting  garments  of  a  nature  suitable  to 
the  season  is  the  best  prevention  in  such  cases. 

Constipation. — A  very  frequent  disease  in  children, 
and  especially  in  infants.  Those  fed  on  the  bottle  are 
most  disposed  to  it.  The  passages  may  be  too  infrequent 
or  too  hard,  and  generally  are  both.  In  treating  the 
affection  the  cause  of  the  difficulty  should  be  sought  and 
removed,  and  laxative  drugs  be  used  as  a  last  resource. 


272  THE   CARE    OE   THE   BABY. 

As  an  increase  of  the  fat  in  the  food  is  often  needed,  a 
larger  proportion  of  cream  can  be  added  to  the  bottle,  or, 
in  the  case  of  breast-fed  babies,  be  fed  from  a  spoon.  A 
teaspoonfnl  or  less  of  olive  oil  given  once  a  day,  or  of 
drng-store  "syrup"  two  or  three  times  a  day,  is  harmless 
and  often  effectual.  The  employment  of  oatmeal-water 
(Appendix,  5)  instead  of  plain  water  in  preparing  the 
bottle,  or  of  brown  sugar  or  a  syrupy  malt  extract  for 
sweetening  it,  may  have  the  desired  laxative  effect. 
When  this  does  not  answer,  a  small  quantity  of  the  oat- 
meal itself  or  of  other  starchy  food  may  be  added  instead 
of  oatmeal-water,  but  this  should  be  done  only  by  a  phy- 
sician's advice.  In  children  over  one  year  of  age  a  little 
stewed  fruit  or  a  baked  apple  may  be  tried  carefully. 
Strained  stewed-prune  juice  is  often  excellent,  and  the 
juice  of  an  orange  is  frequently  ver}'  serviceable.  A  little 
of  either  of  these  may  sometimes  be  given  with  advan- 
tage even  to  a  younger  baby.  In  still  older  children  the 
diet  should  contain  plenty  of  fluid,  and  of  foods  that  are 
somewhat  laxative.  Among  these  may  be  mentioned 
oatmeal,  graham  bread,  butter,  green  vegetables,  fruit,  etc. 
The  very  early  cultivation  of  a  habit  of  regularity  helps 
to  prevent  constipation.  At  a  certain  fixed  hour,  best 
after  one  of  the  principal  meals,  generally  breakfast,  the 
baby  as  soon  as  old  enough  may  be  supported  on  its 
nurser\'  chair  and  kept  there  for  five  minutes  at  least, 
but  never  permitted  to  strain.  A  daily  cool  bath  fol- 
lowed by  brisk  friction  is  of  decided  benefit.  Daily  mas- 
sage of  the  abdomen  is  an  excellent  remedy,  practised 
just  before  the  hour  at  which  an  evacuation  is  desired. 
The  palm  of  the  hand  should  be  applied  with  gentle 
pressure  just  above  the  right  groin,  and  be  carried  in  a 
horseshoe-shaped  curve  up  to  the  edge  of  the  ribs,  across 
to  the  left  side,  and  down  toward  the  left  groin,  thus  fol- 


THE   SICK  BABY.  273 

lowing  the  course  of  the  large  intestine  and  propelling  its 
contents  toward  the  opening.  The  hand  should  be 
warm,  a  little  sweet  oil  or  vaseline  should  be  used,  and 
the  massage  should  last  about  ten  minutes. 

The  treatment  detailed  is  intended  for  habitual  consti- 
pation. For  the  immediate  unloading  of  the  bowel  one 
of  the  simplest  and  least  harmful  methods  is  the  giving 
of  an  enema  of  warm  water  containing  salt  in  the  pro- 
portion of  a  teaspoonful  to  a  pint.  Soapy  water  may  be 
used  instead  if  something  stronger  is  needed.  The 
amount  to  be  injected  varies  with  the  age.  For  young 
babies  four  to  eight  ounces  are  sufficient,  and  for  those  of 
two  years  three  or  four  times  this  amount.  Either  the 
infant's,  the  hard- rubber,  or  the  fountain  syringe  may  be 
used,  according  to  the  amount  of  fluid  to  be  given.  A 
useful  injection  consists  of  half  a  teaspoonful  of  glycerin 
with  four  or  five  times  as  much  water,  or,  if  this  does  not 
answer,  of  glycerin  in  full  strength.  This  is  best  given 
from  a  small  hard-rubber  syringe  holding  not  more  than 
an  ounce.  The  opening  in  the  nozzle  should  be  larger 
than  ordinary,  as  the  glycerin  does  not  flow  readily.  If 
the  mass  in  the  bowel  is  large  and  very  hard,  an  injection 
of  half  an  ounce  of  warm  sweet  oil,  retained  some  hours 
if  possible,  is  better  than  anything  else.  It  should  be 
followed  by  an  enema  of  soapy  water.  In  some  cases  it 
is  necessary  to  insert  the  finger  or  a  small  smooth  spoon- 
handle  into  the  bowel  and  break  up  the  masses  carefully. 

Glycerin  suppositories  (glycerin  and  soap)  of  a  size  for 
children  are  often  excellent  for  emptying  the  bowel. 
Gluten  suppositories  are  also  serviceable  in  many  in- 
stances. A  more  economical  plan  is  to  employ  little 
home-made  suppositories  of  Castile  soap,  or,  in  place  of 
these,  a  soap  stick,  which  also  can  be  made  at  home,  and 
which  has  the  advantage  of  lasting  for  repeated  usings. 

18 


274  '"^^^   CARE    OF   THE   HA  BY. 

It  consists  of  a  smooth,  conical  stick  of  firm  Castile  soap 
two  or  more  inches  long,  half  an  inch  thick  at  the  base, 
and  tapering  toward  the  other  end  to  the  thinness  of 
about  one-quarter  of  an  inch  (Fig.  68).  It  should  be 
greased  with  vaseline  before  using  it,  in- 
serted part  way  into  the  bowel,  and  held 
there  until  a  tendency  to  an  evacuation 
shows  itself. 

If  none  of  the  methods  described  are 
effectual,  laxative  drugs  must  be  employed. 
Their  use,  however,  ought  to  be  deferred  as 
long  as  possible,  and  is  much  better  left  to 
a  physician.  One  of  the  best  and  least 
harmful  of  drugs  is  cascara  in  some  form. 
iG.  .— boap  'pj^igj-g  ^j-£  some  preparations  of  cascara  which 
have  a  pleasant  taste  and  are  very  effectual. 
Another  very  useful  preparation  is  the  syrup  of  senna, 
which  is  easily  taken  by  children,  as  its  taste  is  agree- 
able. Little  sugar-coated  pills  each  containing  -^-^  grain 
or  less  of  aloin  are  sometimes  of  service,  one  being  given 
daily  to  a  child  of  two  years.  A  small  quantity  of 
manna,  about  5  grains,  can  be  given  to  a  baby  of  six 
months  once  a  day  or  oftener,  dissolved  in  the  milk,  as 
its  taste  is  sweet,  or  10  grains  of  phosphate  of  soda  may 
be  used  in  a  similar  manner.  JMagnesia  or  spiced  syrup 
of  rhubarb  answers  very  well,  but  only  for  occasional  use. 

Colic. — Severe  pain  in  the  abdomen,  usually  due  to 
distention  by  gas.  It  is  one  of  the  commonest  ailments 
of  infancy,  and  frequently  appears  in  those  perfectly  well 
in  other  respects.  It  may  occur  either  only  occasionally 
or  many  times  every  day.  The  symptoms  consist  of 
sudden  and  violent  crying — which  may  continue  until 
the  child   is  bluish  in  the  face  and  often  exhausted  and 


THE   SICK  BABY.  275 

cold — a  swollen  and  hard  abdomen,  and  alternate  doub- 
ling up  and  straightening  of  the  legs,  arms,  and  trunk. 
These  symjDtoms  last  a  variable  time  and  then  suddenly 
cease,  perhaps  preceded  by  the  passage  of  wind  by  the 
mouth  or  bowel.  Chilling  of  the  skin  and  indigestion 
are  the  commonest  causes,  the  latter  depending  on  unsuit- 
able food,  or  too  frequent  or  too  abundant  feeding.  To 
prevent  repeated  attacks  the  stomach  should  be  allowed 
to  rest  by  diminishing  the  amount  of  nourishment  and 
increasing  the  length  of  time  between  feedings.  If  the 
baby  is  bottle-fed,  it  may  be  necessary  to  change  the 
character  of  the  food  in  some  way,  but  this  should  be  the 
duty  of  the  physician.  The  child  must  be  warmly 
clothed,  since  any  chilling  of  the  surface  may  cause  pain, 
no  matter  how  good  the  digestion  may  be.  The  feet  and 
legs  especially  should  be  kept  warm  by  thick  loose  socks 
and  by  daily  friction  with  a  mixture  of  i  part  of  turpen- 
tine and  3  parts  of  sweet  oil.  An  abdominal  binder  may 
be  worn  if  one  is  not  already  in  use. 

During  an  attack  the  baby  must  never  be  fed.  The 
warm  milk,  it  is  true,  often  stops  the  crying  for  the  mo- 
ment, but  it  is  sure  to  increase  the  indigestion  and  to 
bring  the  pain  back  as  bad  as,  or  worse  than,  ever. 
Rubbing  the  abdomen  for  several  minutes,  or  the  mere 
change  of  the  child's  position,  as  by  lifting  it  over  the 
shoulder,  will  sometimes  cause  the  gas  to  escape  and  the 
colic  to  cease,  A  spice  plaster  (Appendix,  68)  is  often  very 
useful.  A  small  hot  water  bag  may  be  used  if  the  infant 
is  sufficiently  quiet.  Thorough  opening  of  the  bowels 
by  an  enema  (p.  273),  as  for  constipation,  is  often  ver}^ 
efficacious.  Generally,  some  medicine  given  internally  is 
necessary.  Peppermint- water  or  cinnamon-water,  diluted 
and  given  after  each  nursing,  may  keep  the  pain  from 
coming  on  ;  while  during  an  attack  one  of  the  simplest 


2/6  THE   CARE    OF  THE   BABY. 

and  most  effectual  remedies  is  soda-mint  (Appendix,  105) 
mixed  with  an  equal  quantity  of  hot  water  and  given 
every  half  hour  or  hour  for  a  time.  If  the  baby  seems 
exhausted  and  cold  as  a  result  of  the  pain,  it  should 
be  given  a  few  drops  of  brandy  in  a  teaspoon ful  of  hot 
sweetened  \vater  and  be  placed  at  once  in  a  hot  bath, 
and  after  that  should  be  kept  very  warm  and  have  a 
mustard  plaster  (Appendix,  69)  applied  over  the  abdo- 
men. The  doctor  should  be  summoned  at  once.  Con- 
stantly-recurring colic,  not  relieved  or  prevented  by  the 
means  described,  is  beyond  the  abilit}-  of  the  mother  to 
treat. 

Congenital  Closure  of  the  Bowel. — Complete  ob- 
struction, oftenest  not  far  within  the  opening  of  the 
bowel,  or  the  entire  absence  of  any  opening.  Failure  on 
the  part  of  the  baby  to  empty  its  bowels  for  one  or  two 
days  after  birth  renders  one  suspicious  of  the  presence  of 
this  condition.  Unless  some  operation  is  performed, 
death  is  inevitable  in  the  course  of  a  few  days. 

Prolapse  of  the  Bowel. — A  protrusion  of  more  or  less 
of  the  bowel  through  the  external  opening.  It  is  usually 
the  result  of  diarrhoea  or  of  the  straining  of  constipation, 
and  o^enerallv  occurs  in  debilitated  children.  In  the 
mildest  and  fortunately  the  most  frequent  cases  only  the 
lining  of  the  bowel  is  pushed  out  for  about  half  an 
inch,  forming  a  dark,  purplish-red,  puckered  ring  out- 
side of  the  opening.  This  can  be  easily  pushed  back, 
or  it  goes  back  of  itself  after  a  little  time.  The  protru- 
sion may  take  place  every  time  the  bowels  are  opened 
with  the  slightest  straining  effort.  In  the  more  serious 
cases  a  protrusion  of  five  or  six  or  more  inches  of  intes- 
tine may  take  place  at  any  movement  of  the  bowels,  or 


THE  SICK  BABY.  2/7 

even  when  the  child  is  walking  or  standing.  The  pro- 
lapsed bowel  gives  at  first  discomfort,  and  soon  actual 
pain  if  not  replaced.  After  the  protrusion  has  occurred 
a  few  times  it  is  apt  to  happen  repeatedly. 

The  first  treatment  is  to  replace  the  prolapse.  The 
child  should  be  laid  upon  its  back  or  stomach  and  the 
protruding  bowel  be  gently  pushed  back  with  the  fingers, 
previously  well  greased  with  vaseline.  To  prevent  the 
recurrence  the  passages  must  be  kept  soft  and  all  strain- 
ing be  avoided.  Cold  bathing  of  the  parts  is  useful. 
While  the  bowels  are  being  moved  some  support  must  be 
given  by  pressing  the  buttocks  together  or  by  placing 
the  child  upon  its  back  and  receiving  the  passages  in  a 
diaper.  A  board  with  a  small  hole  in  it  three  or  four 
inches  in  diameter,  placed  over  the  chamber,  gives  great 
support  and  tends  to  prevent  prolapse.  In  cases  which 
do  not  readily  yield  to  this  treatment  astringent  injec- 
tions or  suppositories  will  be  prescribed  by  the  physician 
in  charge.     Very  bad  cases  need  operation. 

Rupture;  Hernia. — A  protrusion  of  a  portion  of  the 
bowel  through  some  weak  spot  in  the  muscles  of  the 
abdominal  walls,  forming  under  the  skin  a  soft,  round 
swelling  which  grows  larger  when  the  child  cries, 
often  disappears  when  it  lies  down,  and  can  easily  be 
pushed  back  into  the  abdomen.  It  is  a  common  affec- 
tion in  infants,  may  even  be  present  at  birth,  and  is  most 
often  seen  at  the  navel,  and  next  in  the  groin.  Hernia 
is  always  dangerous  if  neglected,  and  should  be  treated 
at  once.  The  physician  in  charge  will  probably  pre- 
scribe a  support  of  some  kind,  perhaps  a  truss,  which 
must  be  worn  the  entire  time.  If  for  an}-  reason  this  is 
taken  oif  for  a  moment,  the  bowel  must  be  kept  in  by 
the  hand.     Recovery  nearly  always  follows  if  treatment 


278  THE   CARE   OF  THE  BABY. 

is  begun  early.  Should  a  baby  with  rupture  begin  to  cry 
persistently,  to  suffer  from  constipation  and  obstinate 
vomiting,  and  to  appear  very  ill,  a  physician  must  be 
called  immediately,  for  it  is  possible  that  the  bowel  has 
been  constricted  at  the  opening  through  the  tissues  and 
has  become  inflamed,  and  the  condition  is  then  very 
serious. 

Worms. — There  are  three  principal  species  of  worms 
which  may  be  found  in  children:  (i)  the  thread-worm; 
(2)  the  round  worm;  (3)  the  tape- worm.  The  first  and 
second  varieties  are  much  the  commonest. 

Worms  produce  only  indefinite  symptoms  or  none  at 
all.  They  may,  it  is  true,  cause  itching  at  the  opening 
of  the  bowel,  picking  at  the  nose,  variable  appetite  and 
other  evidences  of  disordered  digestion,  restlessness  at 
night,  grinding  the  teeth,  and  perhaps  even  convulsions, 
but  many  other  disturbances  of  the  digestive  canal  can 
produce  these  symptoms  equally  well.  The  great  major- 
ity of  the  children  who  are  supposed  by  their  mothers  to 
have  worms  are  suffering  from  something  else. 

(i)  Thrcad-ivonns  or  scat-zvor))is  strongly  resemble 
little  pieces  of  white  cotton  thread  from  ]-{  to  V^,  inch 
long  (PI.  II.,  Fig.  2).  They  occupy  the  lower  part  of  the 
bowel,  and  coat  the  passages  in  great  numbers.  This 
species  is  the  one  particularly  liable  to  cause  at  night 
severe  itching  of  the  opening  of  the  bowel.  Treatment 
consists  in  great  cleanliness  and  the  injection  every  other 
night  for  a  week  or  two  of  as  much  of  an  infusion  of 
quassia  (x^ppendix,  83)  as  the  child  can  hold  comfortably. 
If  this  does  not  answer,  medical  advice  wall  be  needed. 

(2)  Round  ivornis  are  reddish-white  in  color  and  resem- 
ble common  earth-worms  in  shape,  but  are  thicker  and 
from  four  to  twelve  inches  long  (PI.  II.,  Fig.  i).     They 


I'l.ATK    II. 


I.  Roundworm.  (Drawn  from  life  ;  one-half  riHtural  size.)  2,  Thread-worms.  (Naiural 
size.)  3.  Small  portions  from  different  parts  in  the  length  of  a  tape-worm.  (Drawn  from  life; 
natural  size.) 


THE  SICK  BABY.  279 

inhabit  the  small  intestine,  bnt  often  wander  into  the 
large  intestine  and  are  evacuated,  and  sometimes  even 
enter  the  stomach  and  are  vomited.  They  are  present  in 
the  bowels  in  great  numbers.  Although  evidences  of 
indigestion  may  be  present,  the  only  characteristic  symp- 
tom is  the  discovery  of  the  worm  in  the  passages.  No 
"worm  medicines"  should  ever  be  given  except  by  the 
family  physician,  for  they  are  not  safe  in  the  hands  of 
others. 

(3)  Tape-zvcnnn  is  occasionally  seen  in  children.  Often 
not  even  the  ordinary  evidences  of  digestive  disturbance 
are  produced  by  it,  and  the  only  way  of  recognizing  that 
there  is  a  worm  is  the  discovery  of  portions  of  it  in  the 
passages  (PL  II.,  Fig.  3).  The  parasite  is  composed  of 
a  great  number  of  segments  joined  together,  making  a 
total  length  of  perhaps  many  feet.  The  segments  are 
smaller  and  smaller  as  they  approach  the  "neck"  and 
the  "head."  The  neck  is  no  thicker  than  a  thread,  and 
the  head  is  only  about  as  large  as  an  ordinary  pin-head. 
The  treatment  of  the  disease  is  beyond  the  skill  of  the 
mother.  It  is  essential  to  remove  the  head  in  order  to 
prevent  a  new  worm  from  forming.  To  be  sure  that  this 
has  been  accomplished  the  bowels  should  be  opened  into  a 
vessel  of  water  and  the  passage  then  be  shaken  about  gently 
and  without  pulling  the  worm  until  the  feces  are  entirely 
separated.  The  water  may  then  be  poured  off  carefully 
and  fresh  added  until  quite  clear,  when  the  worm  may 
be  examined.  The  worm  should  never  be  pulled  upon 
while  it  is  being  passed,  lest  the  head  be  broken  off  in 
the  bowel. 

Jaundice. — A  very  common  affection  in  early  life, 
characterized  by  yellowness  of  the  skin,  the  whites  of  the 
eyes,  and  the  lining  of  the  mouth,  and  by  highly  colored 


28o  THE   CARE    OF   THE  BABY. 

urine  which  stains  the  diapers  yellow.  Occurring  in  the 
first  week  of  life,  it  is  particularly  frequent  and  generally 
very  slightly  developed,  as  the  eyes  are  not  involved  and 
the  urine  not  discolored.  In  such  cases  the  condition 
may  almost  be  called  physiological.  No  other  symptoms 
are  present.  In  more  severe  cases,  either  at  this  age  or 
later,  some  disease  of  the  digestive  apparatus,  or  occa- 
sionally some  serious  constitutional  disturbance  or  malfor- 
mation, is  usually  the  cause.  The  jaundice  is  more  intense 
and  prolonged,  the  eyes  and  urine  are  discolored,  and  the 
passages  from  the  bowel  are  often  clay-colored,  and  there 
are  symptoms  showing  that  the  child  is  not  well  in  other 
respects.  No  treatment  is  required  for  the  mildest  form 
described,  which  occurs  in  the  first  few  days  of  life.  In 
severe  cases  any  treatment  needed  must  be  left  to  the 
physician  in  charge.  Older  children  may  have  a  light 
diet,  as  of  beef-tea  or  milk  foods,  and  be  given  magnesia 
or  some  laxative  mineral  water.  Some  medicine  is 
generally  required,  as  the  discoloration  is  liable  to  be 
ver}^  persistent  at  times. 

(2)   DISEASES   OF   THE   ORGANS   OF   RESPIRATION. 

Cold  in  the  Head  ;  Coryza. — A  disorder  to  which 
children  are  particularly  liable  on  account  of  the  greater 
sensitiveness  of  their  skin.  To  avoid  it  draughts  must 
be  carefully  shunned,  particularly  upon  the  nearly  bald 
head  of  a  baby,  clothing  must  be  sufficiently  warm,  yet 
not  too  warm,  and  the  general  health  must  be  made 
robust  by  an  outdoor  life  and  the  avoidance  of  over- 
heated and  ill-ventilated  rooms.  It  is  probable  that 
micro-organisms  also  play  an  important  part  in  the  pro- 
duction of  colds,  since  the  disease  often  attacks  several 
members  of  a  family  or  even  becomes  epidemic.  It  is 
also  certain  that  the  presence  of  adenoid  growths  in  the 


THE  SICK  BABY.  28 1 

nose,  or  of  some  other  chronic  derangement,  greatly  pre- 
disposes to  repeated  attacks. 

The  symptoms  of  coryza  consist  in  watering  eyes, 
sneezing,  running  nose,  and  a  nasal  tone  of  the  voice. 
Some  degree  of  fever  is  often  present.  The  disease  is 
troublesome  in  infancy,  for  the  obstruction  to  the  breath- 
ing renders  sucking  difficult.  One  of  the  great  dangers 
dependent  on  coryza  is  inflammation  of  the  ears,  or,  in 
case  colds  are  of  frequent  occurrence,  permanent  deaf- 
ness. 

Treatment  consists  in  giving  the  child  a  warm  bath  or 
a  mustard  foot-bath  in  a  warm  room,  drying  it  carefully 
and  rapidly,  and  keeping  it  in  a  temperature  which  is 
very  equable  and  rather  higher  than  usual.  It  is  better, 
indeed,  to  put  the  child  to  bed.  The  diet  should  be 
lighter  than  usual.  A  laxative,  preferably  castor  oil, 
should  be  given,  and  a  fever  mixture  (Appendix,  io8)  if 
needed.  It  is  often  useful  to  apply  vaseline  within  the 
nose  with  a  camel' s-hair  pencil,  and  also  to  rub  it  upon 
the  bridge.  A  fine  spray  of  liquid  vaseline  may  also  be 
used  in  the  nose  (p.  259),  but  this  is  best  ordered  by  the 
physician. 

Spasmodic  Croup. — This  disease,  although  very  alarm- 
ing, is  fortunately  not  often  dangerous.  It  is  generally  the 
result  of  exposure  to  cold,  but  is  sometimes  due  to  indi- 
gestion or  to  irritation  of  the  throat.  Some  children  are 
very  liable  to  suffer  from  repeated  attacks,  while  others 
never  do,  however  severely  they  may  take  cold.  Often 
there  is  an  evident  family  predisposition.  The  symptoms 
may  or  may  not  begin  with  hoarseness  during  the  day, 
and  toward  night  the  peculiar  sharp,  barking,  metallic, 
' '  croupy ' '  cough.  After  the  child  has  been  asleep  for  a  few 
hours  it  awakes  suddenly,  sits  upright  and  grasps  at  any- 


282  THE    CARE    OF   THE   BABY. 

thing  it  can  reach,  and  is  scarcely  able  to  get  its  breath. 
The  cronpy  cough  is  now  loud  and  very  characteristic,  the 
respiration  labored,  the  inspiration  of  air  noisy,  the  voice 
hoarse,  and  the  face  perspiring  and  of  a  bluish  tint.  The 
worst  of  the  condition  lasts  only  a  short  time,  but  a  ten- 
dency to  croupy  cough  and  oppressed  breathing  may  per- 
sist for  some  hours,  after  which  the  child  drops  asleep, 
and  usually  rests  quietly  for  the  remainder  of  the  night. 
Another  attack  is  very  apt  to  occur  upon  each  of  several 
succeeding  nights. 

The  disease  is  commonest  in  the  third  year  of  life,  and 
then  as  a  rule  steadily  decreases  in  frequency.  It  is  seen 
only  occasionally  after  the  age  of  six  years.  In  some 
cases  an  unusual  degree  of  catarrhal  laryngitis  accom- 
panies the  spasmodic  contraction  of  the  larynx.  In  these 
the  croupiness  does  not  appear  so  quickly  at  night,  and 
tends  to  persist  more  or  less  during  the  day  as  well.  These 
cases  suggest  diphtheria  strongly  and  must  be  studied 
very  carefully. 

Treatment  is  primarily  preventive.  Croupy  children 
should  be  guarded  with  especial  care  against  exposure  to 
wind  and  dampness.  On  the  slightest  sign  of  croupiness  in 
the  afternoon  the  mother  should  administer  some  medi- 
cine prescribed  by  the  physician  ;  or,  in  case  she  has  no 
such  preparation,  she  can  use  that  given  in  the  Appendix 
(109).  This  is  not  one  of  the  strongest,  but  is  one  which 
she  can  safely  give  without  medical  advice. 

In  the  treatment  of  the  attack  a  warm  mustard  bath 
and  an  emetic  (Appendix,  iii)  should  be  given,  the  latter 
being  repeated  in  twenty  minutes  if  it  has  had  no  effect. 
Moistening  the  air  with  the  steam  atomizer  or  the  croup 
kettle  (p.  230)  is  of  great  service.  There  is  absolutely  no 
value  in  amber  necklaces  and  such  other  relics  of  bar- 
baric superstition,  except  the  sedative  action  upon  the 


THE   SICK  BABY.  283 

mind  of  the  mother.    Instances  of  apparent  cure  by  them 
are  merely  coincidences. 

Membranous  Croup. — See  Diphtheria. 

Bronchitis. — An  inflammation  of  the  bronchial  tubes 
accompanied  by  cough.  It  is  a  very  common  affection  in 
children.  The  causes  are  the  same  as  those  of  coryza  (p. 
280),  and  an  attack  of  this  usually  precedes  the  bronchitis. 
Any  hoarseness  present  is  due  to  laryngitis.  The  cough 
is  frequent,  at  first  dry  and  tight,  but  later  becoming 
loose  and  rattling  as  the  inflammation  diminishes.  Often 
some  wheezing  or  rattling  can  be  heard  with  respiration. 
The  child  does  not  seem  very  sick  unless  the  bronchitis 
is  unusually  severe  ;  has  but  slight  fever,  and  breathes 
but  little,  if  any,  more  rapidly  than  natural.  It  may 
cough  up  a  good  deal  of  mucus,  but,  before  the  age  of 
six  or  seven  years,  nearly  always  swallows  this  instead 
of  spitting  it  out.  The  only  treatment  the  mother  may 
venture  on  is  the  general  method  advised  for  cold  in  the 
head,  combined  with  a  thorough  rubbing  of  the  chest, 
both  in  front  and  behind,  twice  a  day  with  oil  of  amber, 
diluted  with  equal  parts  of  sweet  oil  if  the  patient  is  less 
than  a  year-  old.  A  physician  should  be  called  in  at 
once,  as  in  infancy  and  early  childhood  the  disease  may 
easily  pass  into  pneumonia. 

Pneumonia. — The  terms  congestion  of  the  lungs.,  pneu- 
monia., capillary  bronchitis.,  and  inflammation  of  the  lungs 
are  to  all  intents  and  purposes  identical  in  meaning. 
The  disease  may  come  on  suddenly,  perhaps  even  with  a 
convulsion  and  without  previous  warning,  or  it  may  de- 
velop from  a  bronchitis  already  present.  There  are  high 
fever,  flushed  cheeks,  a  frequent,  painful,  and  very  short 


284  THE    CARE    OF   THE  BABY. 

congli,  and  rapid  catching  breathing,  with  a  moving  in 
and  out  of  the  edges  of  the  nose,  and,  in  bad  cases,  of 
the  pit  of  the  stomach  and  the  spaces  between  the  ribs, 
and  a  tugging  of  the  muscles  of  the  neck.  The  child  is 
restless  and  tossing,  or,  if  very  sick,  sometimes  lies  quiet 
with  its  cheeks  and  lips  pale  and  bluish  and  its  breathing 
very  rapid  and  shallow. 

The  disease  is  always  serious,  and  requires  the  com- 
bined skill  and  attention  of  the  physician,  nurse,  and 
mother.  In  addition  to  what  was  said  in  the  general  re- 
marks on  disease  and  on  nursing  earlier  in  this  chapter, 
it  may  be  stated  here,  first,  that  the  labored  breathing 
shows  the  need  of  plenty  of  fresh  air,  although  without 
draughts;  second,  that  the  child  may  be  allowed  to  assume 
any  position  it  pleases,  and  that  a  change  of  position  may 
give  great  relief;  third,  that  in  any  case  where  blueness, 
pallor,  and  failure  of  the  powers  are  coming  on  rapidly, 
a  hot  bath  may  be  administered  w^hile  the  doctor  is  being 
sent  for,  and  may  save  the  baby's  life  (see  p.  397). 

(3)   DISEASES   OF  THE   BRAIN  AND   NERVOUS  SYSTEM 
AND   OF  THE   SPECIAL  SENSES. 

Convulsions,  Spasms. — One  of  the  most  common 
and  dangerous  diseases  of  infancy  and  early  childhood, 
demanding  knowledge,  presence  of  mind,  and  decision 
on  the  part  of  the  mother.  Among  the  various  causes  are 
the  onset  of  some  severe  illness — such  as  pneumonia  or 
scarlet  fever, — indigestion,  constipation,  intestinal  worms, 
high  fever  from  whatever  source,  disordered  dentition, 
diseases  of  the  brain,  very  hot  weather,  fright,  severe 
pain,  rickets,  whooping-cough,  etc.  The  frequency  of 
convulsions  is  much  the  greatest  in  infancy,  and  rapidly 
diminishes  after  the  first  year.  In  the  mildest  attacks, 
often   called   "inward   spasms,"   there   may   be   only  a 


THE   SICK  BABY.  285 

tendency  to  squint  and  to  bend  the  thumbs  into  the 
pahns,  with  shght  twitching  of  the  mouth  or  eyelids, 
and  perhaps  of  the  head  or  limbs.  These  symptoms  may 
pass  away  in  a  moment,  may  last  unchanged  for  hours, 
or  may  usher  in  a  fully  developed  attack. 

In  a  typically  severe  convulsion  the  child  often  makes 
a  choking  sound,  ceases  to  breathe  for  a  moment,  and 
becomes  unconscious,  stiff,  and  somewhat  arched  back- 
ward. The  eyes  are  staring,  rolling,  or  squinted,  the 
hands  clenched,  and  the  mouth  firmly  shut.  In  a  few 
seconds  the  face  becomes  bluish  from  lack  of  air  in  the 
lungs,  and  then  the  "working"  begins.  In  this  stage 
the  breathing  is  irregular  and  noisy;  the  arms,  legs,  and 
trunk  are  jerked  about  in  all  directions,  but  principally 
with  alternate  bending  and  straightening  movements  ; 
the  eyes  are  rolled;  there  is  frothing  at  the  mouth,  and 
the  teeth,  if  there  are  any,  are  ground  together  and  may 
bite  the  tongue.  In  a  few  moments  the  movements  grow 
less  violent  and  then  cease,  and  the  child  begins  to  cry 
or  goes  into  a  heavy  sleep  with  its  body  rather  stifFer 
than  usual.  Sometimes  before  consciousness  is  regained 
or  the  rigidity  has  disappeared,  another  spasm  occurs, 
and  so  the  child  may  go  on  from  fit  to  fit  until  it  dies. 
The  whole  attack  lasts  from  one  or  two  minutes  to 
hours. 

Treatment  must  be  very  prompt.  The  child  should 
at  once  have  a  bath  of  ioo°  F.  which  should  cover  it 
to  its  neck,  while  cold  cloths,  frequently  renewed,  are 
kept  on  its  head.  It  must  be  left  in  the  water  for  ten 
minutes,  and  then  be  wrapped  in  a  blanket  without  dry- 
ing. Since  the  attack  may  be  due  to  irritating  food  in 
the  stomach,  the  child  should  be  made  to  vomit  by  giv- 
ing it  a  teaspoonful  of  syrup  of  ipecacuanha  or  other 
emetic  (Appendix,  iii)  just  as  soon  as  it  can  be  made  to 


286  THE    C.IA'E    OF  THE   BABY. 

swallow.  If  the  fit  still  continues  and  the  doctor  has  not 
come,  the  bowel  should  be  washed  out  with  a  large  injec- 
tion of  warm  water,  and  this  be  followed  by  one  suitable 
to  quiet  the  nervous  system  (xA.ppendix,  87),  the  latter 
injection  being  held  in  by  pressure  of  the  thumb  over  the 
opening  of  the  bowel.  Fortunately,  the  hot  bath  and 
the  emetic  answer  every  purpose  in  most  cases,  and 
relieve  the  attack  in  a  few  minutes,  sparing  the  mother 
the  responsibility  of  using  the  injection,  which  is  one  of 
decided  power. 

In  very  severe  cases  which  have  resisted  other  treat- 
ment and  where  no  physician  can  be  obtained,  the  child 
may  be  made  to  inhale  a  small  quantity  of  ether  poured 
upon  a  towel  and  held  close  to  the  nose.  This  should  be 
kept  up  only  until  relaxation  of  the  body  and  cessation 
of  the  convulsive  movements  occur.  It  must  be  borne 
in  mind  that  ether  in  unskilled  hands  is  dangerous.  It 
should  be  used  only  as  a  last  resort,  and  because  not  to 
use  it  is  the  greater  evil. 

The  convulsions  of  epilepsy  are  identical  in  appearance 
with  the  ordinary  spasms  described.  They  may  begin  in 
'early  infancy,  and  in  such  cases  can  be  distinguished 
only  by  the  persistent  recurrence  of  the  fits  as  the  child 
grows  older.  No  special  treatment  is  needed  during  the 
epileptic  convulsion,  other  than  placing  the  child  in  a 
comfortable  position,  guarding  it  from  injuring  itself  and 
loosening  the  clothing  about  the  neck.  No  effort  should 
be  made  to  straighten  the  arms,  bend  out  the  thumbs, 
hold  down  the  legs,  and  the  like. 

Night-terrors. — In  this  disease  a  child  of  from  two  to 
six  years  or  older,  apparently  in  perfect  health,  starts 
suddenly  from  sleep,  screaming  and  cold  with  fright, 
stands  in  bed  or  even  runs  through  the  room,  does  not 


THE   SICK  BABY.  28/ 

seem  thoroughly  conscious,  fails  to  recognize  its  mother, 
and  cannot  be  pacified.  Night-terrors  differ  froin  an 
ordinary  nightmare  in  the  confusion  and  fright  which 
persist  after  waking,  and  in  the  child's  inability  to  tell 
afterward  what  frightened  it.  As  a  rule,  the  attacks,  of 
which  there  is  usually  but  one  in  the  course  of  the  night, 
come  on  after  one  or  two  hours'  sleep,  and  last  but  a 
few  minutes.  They  may  occur  every  night  or  only  at 
irregular  intervals,  and  in  rare  cases  they  take  place  even 
while  the  child  is  awake  during  the  day.  The  principal 
causes  are  probably  some  disturbance  of  digestion  and 
the  existence  of  a  highly  sensitive  nervous  system. 
Treatment  consists  in  careful  diet  if  there  is  indigestion, 
the  avoidance  of  excitement,  a  healthy  outdoor  life,  and 
especially  the  giving  of  a  very  light  evening  meal.  If 
this  does  not  cure  and  the  attacks  are  frequent,  medical 
advice  should  be  obtained,  as  bad  cases  may  possibly  run 
into  epilepsy. 

Sleeplessness ;  Insomnia. — This  arises  from  a  great 
many  different  sources,  and  the  treatment,  of  course, 
varies  accordingly.  Among  the  causes  may  be  men- 
tioned colic  or  pain  of  any  other  nature;  constipation; 
indigestion;  too  much  sleep  during  the  day;  too  early 
going  to  bed;  too  exciting  play  just  before  bedtime; 
hunger  resulting  from  too  long  an  interval  between  nurs- 
ing and  putting  to  rest;  too  hearty  a  supper  in  the  case 
of  older  children;  not  enough  fresh  air  during  the  day; 
imperfect  ventilation  and  over-heating  of  the  bed-room; 
hot  bed-covering  at  night;  cold  feet;  a  bright  light  in  the 
room,  and  the  sound  of  voices  penetrating  into  it.  The 
remedies  for  these  causes  are  self-evident.  K  baby  nursed 
too  frequently  during  the  day  may  show  the  force  of 
habit    by  desiring    to    be    fed    often    during   the  night, 


288  THE    CARE    OF   THE  BABY. 

althoiigh  not  actually  hungry.  When  a  baby  begins  to 
fret  as  though  sleepy,  and  yet  will  not  sleep,  it  is  fair  to 
presume  that  it  has  been  over-fatigued.  It  is  "too  tired 
to  sleep."  Prevention  is  the  only  cure  for  this.  In 
many  cases,  especially  in  nervous  subjects,  there  seems 
to  be  no  cause  whatever  for  insomnia  except  an  individ- 
ual peculiarity,  and  the  child  may  lie  in  bed  entirely 
comfortable,  yet  equally  wakeful.  In  such  cases  it  is 
often  a  good  plan  to  give  the  daily  bath  at  bedtime,  mak- 
ing it  slightly  warmer  than  usual,  in  order  to  obtain  its 
sedative  action,  and  simply  to  sponge  in  the  morning. 
Sometimes  putting  the  child  to  bed  at  a  rather  later  hour 
is  of  service. 

There  is  a  large  selection  among  drugs  useful  in  sleep- 
lessness, and  some  of  them  are  decidedly  harmful  under 
certain  conditions.  The  one  to  be  chosen  requires  very 
careful  consideration,  and  the  mother  should  never  give 
any  of  them  except  by  medical  advice. 

Headache, — Pain  in  the  head  is  of  frequent  occurrence 
in  children,  and  even  in  babies.  Older  children  com- 
plain directly  of  it,  but  in  infants  it  can  be  recognized 
only  by  a  wrinkling  of  the  brows,  persistent  crying,  a 
rolling  of  the  head  from  side  to  side,  or  the  moving  of 
the  hand  toward  the  painful  region.  The  causes  of  head- 
ache are  very  numerous,  and  often  difficult  to  ascertain. 
Among-  the  most  common  of  them  are  forms  of  brain 
disease,  and  especially  meningitis,  fever  from  any  cause, 
neuralgia,  indigestion  and  constipation,  fatigue,  im- 
poverishment of  the  blood,  strain  of  the  eyes  at  school, 
confinement  in  badly  ventilated  rooms,  lack  of  outdoor 
exercise,  excessive  mental  work,  general  debility,  and 
disease  of  the  heart  or  kidneys.  To  distinguish  which  is 
the  acting  cause,  and  then  to  determine  what  treatment 


THE   S/Ck'  BABY.  289 

is  required,  are  usually  beyond  a  mother's  power.  Rest, 
the  prevention  of  noises,  bathing  the  head  with  cold 
water  or  bay  rum,  a  mustard  plaster  at  the  back  of  the 
neck,  a  mustard  foot-bath,  restricted  diet,  and  the  admin- 
istration of  a  laxative  may  be  tried  without  danger. 

St.  Vitus's  Dance;  Chorea.  —  A  nervous  disorder 
chiefly  seen  in  children,  characterized  by  irregular  jerk- 
ing movements  of  the  arms  and  legs,  often  with  grimaces 
and  sometimes  with  decided  loss  of  power.  The  attack 
frequently  begins  with  what  appears  to  be  awkwardness, 
the  child  dropping  its  food  at  the  table,  and  having  a 
tendency  to  walk  awkwardly  or  trip  over  things. 

The  disease  may  become  so  severe  that  the  child  is 
unable  to  feed  or  dress  itself,  or  even  to  walk. 

The  commencement  of  the  affection  often  can  be  traced 
to  a  fright  or  to  overwork  at  school  or  other  nervous 
strain.  It  also  appears  to  be  especially  liable  to  develop 
in  rheumatic  children.  Its  great  danger  is  that  it  may 
be  followed  by  heart  disease. 

The  child  should  be  taken  from  school,  and  all  sources 
of  excitement  removed.  Sometimes  confinement  to  bed 
is  necessary.     In  all  cases  medical  treatment  is  required. 

Paralysis  ;  Palsy. — A  widespread  or  limited,  more  or 
less  complete  loss  of  power.  There  are  various  causes 
and  forms  of  the  disease.  Sometimes  the  pressure  occur- 
ring naturallv  during  a  tedious  confinement,  or  less  often 
that  occasioned  by  the  use  of  instruments,  injures  the 
brain,  and  both  affects  the  mind  and  produces  a  birth- 
palsy  as  well.  Generally  the  arm  and  leg  of  only  one 
side  are  affected,  yet  both  sides  are  not  infrequently  in- 
volved. This  form  of  birth-palsy  may  improve  con- 
siderably or  may  become  worse  with  advancing  years. 

19 


290  THE    CARE    OF   THE   BABY. 

Sometimes  a  paralysis  of  one  side  of  the  face  or  of  one 
arm  occurs  during  birth  from  stretching  of  or  other  injury 
to  a  nerve,  the  brain  having  nothing  to  do  with  it.  This 
variety  will  generally  recover  in  a  few  weeks  or  montlis. 

There  is  ?i  paralysis  following  diphtheria  which  attacks 
especially  the  muscles  of  the  throat  and  eyes,  causing 
food  to  enter  the  back  of  the  nose  and  producing  squint. 
Occasionally  it  affects  the  whole  body.  Recovery  is 
usually  complete. 

Paralysis  of  a  somewhat  similar  nature,  due  to  inflam- 
mation of  the  nerves  not  the  result  of  diphtheria,  is 
occasionally  seen, 

A  paralysis  due  to  disease  of  the  spinal  cord  is  frequent 
in  children.  The  commonest  form  begins  suddenly  with 
fever,  restlessness,  sometimes  convulsions,  more  or  less 
delirium,  and  other  vague  symptoms.  No  diagnosis  is 
possible  until  in  a  day  or  so  paralysis  of  one  or  more 
extremities  develops.  Sometimes  the  onset  is  even  more 
sudden,  and  a  child,  well  on  going  to  bed,  is  found  para- 
lyzed in  the  morning.  Considerable  improvement  takes 
place,  though  slowly,  but  more  or  less  loss  of  power 
and  wasting  of  the  limbs  will  probably  remain  through 
life. 

Another  form  of  spinal  paralysis  is  that  occurring  in 
curvature  of  the  spine.     (See  PolC s  Disease.,  p.  302.) 

The  greatest  perseverance  in  carrying  out  the  treat- 
ment is  necessary  in  all  forms  of  paralysis.  The  affected 
parts  are  frequently  cold,  and  need  to  be  dressed  very 
warmly.  After  the  acute  stage  is  over  thorough  rubbing 
and  kneading  must  be  kept  up  day  after  day  for  months 
in  the  effort  to  maintain  and  to  increase  the  strength  of 
the  muscles.  The  physician  in  charge  may  ad\'ise  elec- 
tricity for  the  same  purpose.  The  child  should  in  most 
cases  be  madfj  to  \ise  the  paralyzed  parts  as  much  as  pos- 


THE   SICK  BABY.  29 1 

sible.  The  use  of  crutches  aud  other  apparatus  must 
not  be  begun  unless  absolutely  unavoidable,  as  this  is 
the  most  certain  way  to  render  them  indispensable 
throughout  life.  If  the  doctor  finds  that  the  child 
really  cannot  learn  to  walk  again,  or  is  developing  de- 
formities in  the  weak  limbs,  he  will  probably  advise 
some  sort  of  brace  which,  with  the  help  of  a  cane;  may 
give  the  needed  support  and  render  crutches  superfluous. 

Hydrocephalus;  Water  on  the  Brain. — This  is  an 
enlargement  of  the  head  resulting  from  a  great  accu- 
mulation of  fluid  within  the  skull.  The  head  and  the 
fontanelles  grow  constantly  larger,  the  latter  bulge,  and 
the  bones  become  thin.  The  shape  is  somewhat  glob- 
ular, so  that  the  face  seems  small  and  the  head  very 
large,  the  forehead  overhanging  the  face,  and  the  sides 
of  the  head  extending  beyond  the  ears.  In  mild  cases 
the  mind  is  not  affected,  but  in  severer  ones  the  child  is 
feeble-minded  and  has  little  control  over  its  body. 

Feeble-mindedness  ;  Idiocy. — Idiocy — which  differs 
from  imbecility  and  feeble-mindedness  only  in  degree — is 
a  condition  which  is  often  born  with  the  child,  although 
it  may  develop  in  infancy  or  childhood  as  the  result  of 
some  disease  or  from  injury  to  the  brain.  A  congenitally 
weak-minded  baby  does  not  notice  as  soon  as  it  should. 
It  will  perhaps  not  follow  a  bright  light  with  its  eyes, 
nor  turn  its  head  toward  the  source  of  a  noise,  long 
after  a  normal  child  does  both  of  these  acts.  As  it  grows 
older  it  is  very  slow  in  learning  to  hold  up  its  head,  to 
sit  up,  or  to  hold  objects  in  its  hands.  Even  by  two 
years  of  age  it  may  make  no  attempt  to  walk  or  to  utter 
any  distinctly-articulated  sound.  Its  face  has  a  vacant 
expression  and  it  slobbers  a  great  deal.     At  three  or  four 


292  THE    CARE    OE   THE   BABY. 

years  of  age  it  may  have  learned  a  few  words  or  may 
still  be  imable  to  speak  or  to  understand  at  all. 

This  description  is  of  a  well-marked  case.  There  are 
all  grades  of  the  condition,  however,  down  to  what  may 
be  called  simply  backwai^diiess^  in  which  the  child's 
powers  are  slow  in  developing,  but  finally  expand  to  a 
fairly  satisfactory  degree  if  carefully  trained.  The  mother 
must  be  able  to  recognize  the  mental  defect  as  early  as 
possible,  with  the  intent  that  she  may  lose  no  time  in 
beginning  the  training.  The  success  at  best  is  slow,  and 
efforts  must  be  unremitting  and  be  uninfluenced  by  dis- 
couragement. Sometimes  it  is  better  to  place  the  child 
in'an  institution  where  its  education  can  be  superintended 
by  those  accustomed  to  this  work. 

Deaf-mutism. — This  resembles  idiocy  so  closely  for 
the  first  few  months  of  life  that  its  recognition  is  dif- 
ficult or  impossible.  A  deaf-mute  takes  no  notice  of 
sound  because  it  cannot  hear  it,  while  a  feeble-minded 
baby  hears,  but  has  not  the  sense  to  notice  it.  By  the 
age  of  six  months  we  should  be  able  to  decide  between 
the  two  conditions.  A  deaf  baby  shows  by  this  time 
none  of  the  bodily  feebleness  or  lack  of  development  of 
the  idiot.  It  has  an  intelligent  expression,  and  will  play 
with  toys  and  smile  at  its  mother,  yet  will  take  no  notice 
of  such  a  sound  as  that  of  a  bell  rung  behind  it.  Very 
loud  noises  may  make  an  impression  upon  it,  either  be- 
cause it  is  not  totally  deaf  or,  more  often,  because  it  fccis 
such  vibrations  as  come,  for  instance,  from  the  slamming 
of  a  door.  The  child's  ears  should  at  once  be  examined 
by  an  aurist,  in  order  that  something  may  be  done,  if  pos- 
sible, before  it  is  too  late.  If  found  incurable,  the  child 
should  when  older  be  trained  to  talk  and  understand  by 
lip-reading,  in  which  so  much  success  has  been  attained 


THE   SICK  BABY.  293 

in  recent  years,  and  wliicli  is  so  superior  to  the  awkward 
deaf-and-dumb  alphabet.  There  are  institutions  which 
are  devoted  solely  to  this  instruction,  and  children  often 
learn  articulate  language  so  well  that  they  talk  audibly 
and  understand  almost  as  if  they  could  hear. 

Congenital  Blindness. — This  cannot  at  first  be  dis- 
tinguished from  idiocy,  which,  indeed,  not  infrequently 
accompanies  it.  Only  time  can  show  the  difference.  A 
feeble-minded  child  will  eventually  learn  to  fix  its  eyes 
upon  objects  unless  it  is  an  absolute  idiot,  in  which  case 
its  mental  deficiency  will  show  itself  in  other  ways  as 
well. 

Inflammation  of  the  Eyes. — This  affection  may  occur 
at  any  age.  The  most  dangerous  form  {ophthalmia  of 
the  new-born^  ophthalmia  neonatorinii)  is  that  which 
develops  a  few  days — usually  about  three — after  birth, 
and  which  may  cause  blindness  in  spite  of  the  most 
careful  treatment.  To  prevent  this  the  eyes  should  be 
carefully  washed  after  birth,  in  the  manner  described  in 
Chapter  IV.  Should  the  inflammation  begin,  the  lids 
stick  together  after  sleep,  and  pus  may  be  found  at  the 
corners  and  on  the  inner  surface  of  the  lower  lid.  The 
lids  soon  swell  greatly,  and  their  lining  and  that  of  the 
eye  itself  is  very  red  and  secretes  an  abundant  thick  dis- 
charge. As  this  is  very  infectious,  the  nurse  must  care- 
fully keep  any  of  it  from  getting  into  her  own  eyes  or 
those  of  the  mother  or  of  other  children,  while  at  the 
same  time  the  baby's  other  eye,  if  sound,  must  be 
guarded  by  an  antiseptic  bandage.  A  physician  must  be 
summoned  without  a  moment's  delay,  since  thorough  and 
early  treatment  of  a  cleansing  and  disinfecting  nature  is 
essential.     The   nurse   must   see   that,   the   eye   is   kept 


294  THE    CARE    OE   THE   BABY. 

scnipulously  clean  by  very  frequent  washing,  and  that 
the  lotion  ordered  really  gets  inside  the  lids.  To  accom- 
plish this  the  baby  should  be  held  on  the  lap,  with  the 
head  inclined  backward  and  toward  the  diseased  side. 
The  lids  must  then  be  gently  separated  and  the  lotion 
dropped  in  from  an  "eye-dropper."  This  consists  of 
an  ordinary  medicine-dropper,  but  with  the  point 
smooth  and  rounded  or  bulbous  to  prevent  accident. 
Absorbent  cotton  wet  with  the  lotion  may  be  used  in- 
stead of  the  dropper.  The  lower  lid  is  drawn  down 
slightly  and  some  of  the  fluid  is  squeezed  upon  it.  The 
solution  should  enter  at  the  corner  next  the  nose.  The 
inclination  of  the  head  carries  it  through  toward  the 
cheek,  thus  keeping  it  away  from  the  sound  eye.  The 
sticking  of  the  lids  may  be  prevented  by  rubbing  their 
edges  with  a  little  vaseline.  Any  cotton  or  cloths  used  for 
washing  the  eye  should  be  burned,  and  the  nurse  should 
disinfect  her  hands  after  each  treatment  of  the  child,  and 
before  she  touches  her  own  eyes  (Appendix,  lOO,  loi). 

Older  infants  and  children  may  suffer  from  various  forms 
of  inflammation.  In  some  of  the  severer  cases  minute 
blisters  or  ulcers  develop  upon  the  front  of  the  eyes,  and 
children  cannot  be  persuaded  to  open  them  at  all  on 
account  of  the  great  pain  which  light  produces.  As  it  is 
difficult  to  distinguish  between  the  serious  and  the  trifling 
inflammations,  a  physician  should  be  consulted  promptly. 
Previous  to  his  visit  the  eyes  may  be  bathed  frequently 
with  cold  water,  and  a  little  soothing  eye-wash  dropped 
into  them  often  (Appendix,  85).  No  poultice  or  bandage, 
or  any  of  the  numerous  eye-washes  sold  in  the  shops, 
should  ever  be  used  without  a  physician's  advice. 

Sometimes  the  edges  of  the  lids  become  chronically  red 
and  inflamed,  and  the  growth  of  the  eyelashes  aff"ected. 
This  occurs  usuallv  in  children  whose  health  has  been 


THE   STCK  BABY.  295 

impaired,  or  sometimes  in  those  exposed  to  too  much  sun- 
light. 

Styes. — Small  inflamed  swellings  on  the  edges  of  the 
lid,  especially  in  older  children,  which  form  in  a  few 
days  and  then  subside,  or  soften  and  discharge,  or,  finally, 
persist  in  the  form  of  little  tumors.  Some  children  are 
very  liable  to  have  styes  repeatedly,  while  others  never 
do.  Often  the  general  health  is  at  fault,  and  demands 
tonics;  while  in  many  cases,  particularly  in  school-chil- 
dren, there  is  some  defect  of  vision  which  needs  exam- 
ination by  an  ophthalmologist.  This  is  especially  the 
case  in  children  who  constantly  develop  styes.  For 
the  relief  of  a  stye  already  present  the  frequent  applica- 
tion of  small,  very  hot  fomentations  is  the  best  method 
of  home  treatment. 

Squint;  Strabismus. — Strabismus  may  be  either  con- 
vergent, producing  a  condition  of  "cross-eye,"  or  di- 
vergent, so  that  one  eye  turns  outward.  Either  one  or 
both  eyes  may  be  affected.  Of  course,  the  mother  can  do 
nothing;  but  there  is  one  thing  she  must  not  do,  namely, 
neglect  it.  Not  only  does  strabismus  detract  greatly 
from  a  child's  good  looks,  but  it  will  finally  produce 
great  impairment  of  the  sight  of  the  affected  eye.  Treat- 
ment ought  to  begin  very  early  in  order  to  be  of  value. 
In  infancy  and  early  childhood  the  dropping  of  certain 
solutions  into  the  eye  may  gradually  correct  the  defect. 
In  other  cases  the  use  of  spectacles  may  be  needed,  or  the 
performing  of  an  operation  which  is  not  at  all  dangerous. 

Inflammation  of  the  Ears  ;  Earache  ;   Running  Ears. 

— Earache    is,   of  course,  only  a   symptom    of  different 
forms  of  inflammation  of  the  ear  which  may  or  may  not 


296  THE   CARE    OE   THE   BABY. 

go  on  to  the  formation  of  pns.  The  child  may  develop 
pain  suddenly  in  the  night,  although  it  was  well  or  had 
only  a  slight  cold  in  the  throat  or  nose  when  it  went  to 
bed.  The  chief  symptom  in  infants  is  loud,  persistent 
crying,  not  relieved  by  anything,  and  sometimes  made 
worse  by  pressure  just  in  front  of  or  just  behind  the 
affected  ear.  Occasionall}'  a  baby  will  raise  its  hand  to 
the  seat  of  pain.  Older  children  can  easily  locate  the 
pain,  although  they  sometimes  refer  it  to  the  teeth. 
There  is  usually  fever  and  some  degree  of  deafness. 
The  pain  may  subside  after  a  few  hours,  or  may  con- 
tinue with  intermissions  even  for  days.  If  pus  is  pro- 
duced, it  will  finally  perforate  the  drum-membrane  and 
be  discharged,  probably  with  relief  of  pain.  If  insuffi- 
ciently cleansed,  the  ear  often  has  a  very  offensive  odor. 
No  medicine  of  any  kind  should  be  dropped  into  the  ear, 
and  no  poultice  or  other  wet  dressing  kept  over  it.  A 
hot-water  bag  or  bottle  held  to  the  ear  will  often  remove 
the  pain  in  a  little  while.  Relief  may  be  obtained  by 
repeatedly  syringing  the  ear  with  water  as  hot  as  can  be 
borne,  the  mother  first  testing  this  against  her  cheek  ; 
or  the  child  may  be  laid  on  the  sound  side  and  the 
water  be  poured  into  the  affected  ear.  It  should  then 
be  turned  over  to  allow  the  water  to  run  out,  and  the  ear 
finally  be  covered  with  hot  dry  flannel.  The  procedure 
must  be  repeated  frequently.  The  child  should  be  kept 
quiet  and  warm,  and  the  temperature  of  the  room  should 
not  be  less  than  70°  F.  The  diet  should  be  light.  A 
laxative  and  a  fever  mixture  (Appendix,  108)  aid  in  re- 
lieving the  inflammation.  If  the  pain  persists  or  if  pus 
is  discharged  from  the  ear,  it  is  best  to  consult  a  physi- 
cian, since,  apart  from  the  chances  of  permanent  deaf- 
ness, there  is  always  danger  that  inflammation  may  ex- 
tend to  the  brain.     In  cases  of  discharge  from  the  ear  the 


THE  SICK  BABY.  297 

mother  may  very  gently  syringe  the  canal  with  warm 
water  as  often  as  is  necessary  to  keep  it  clean,  but 
should  put  no  plug  of  cotton  into  it  unless  the 
child  is  going  into  the  open  air.  The  best 
syringe  for  her  to  use  is  a  small  bulbous  one, 
called  the  "  Ear  and  ulcer  syringe,"  which  is 
made  of  soft  rubber  throughout  (Fig.  69). 


'  ~-^^SSs^. 


Toothache. — This  is  most  apt  to  occur  after 
infancy  is  passed,  and  is  generally  due  to  ne-  p-jg/^lE^ 
glected  decay  of  the  teeth.  The  pain  is  often  syringe, 
intense.  A  hot  water  bag  held  against  the 
face  frequently  gives  relief.  Sometimes  a  cavity  can  be 
discovered  in  the  affected  tooth.  If  a  very  small  bit  of 
cotton  is  moistened  with  oil  of  cloves,  and  packed  well 
into  this,  the  pain  may  be  relieved.  Of  course,  a  child 
should  see  a  dentist  as  soon  as  possible  in  order  to  prevent 
a  return  of  the  trouble. 

(4)   DISEASES  OF  THE   BONES,    MUSCLES,    SKIN,    ETC. 

Deformities  of  the  Head. — An  alteration  in  the  shape 
of  the  head  may  occur  as  a  result  of  prolonged  pressure 
received  during  birth.  The  deformity  is  due  partly  to 
the  displacement  of  the  bones,  but  chiefly  to  swelling  of 
the  scalp.  Attention  is  called  to  it  here  because  it  is 
often  the  source  of  great  though  entirely  needless  anxiety 
on  the  part  of  the  mother.  If  it  is  let  alone,  it  will  be  all 
right  in  a  few  days.  On  no  account  should  any  attempt 
be  made  to  squeeze  it  into  shape.  A  distorted  and  marked 
head  is  sometimes  the  imavoidable  result  of  delivery  by 
instruments.  Here,  too,  the  traces  of  deformity  will  usually 
disappear  in  a  short  time.  In  exceptional  cases  a  lump 
on  the  head,  even  as  large  as  an  ^%g^  is  produced  by  an 


298  THE    CARE    OF   THE  BABY. 

accumulation  of  blood  under  the  skin,  or  in  other  very  un- 
usual instances  by  a  portion  of  the  brain  or  its  membranes 
protruding  through  an  unnatural  opening  in  the  skull 
and  elevating  the  skin  over  it.  Such  a  deformity  as  the 
latter  does  not,  of  course,  disappear.  In  hydrocephalus 
and  in  rickets  there  is  a  deformity  of  the  head  character- 
istic of  each  respectively — in  the  one  globular  and  in 
the  other  square.  These  deformities  are  better  consid- 
ered in  connection  with  other  symptoms  of  the  two 
diseases. 

Protruding  Ears. — Mothers  are  often  exercised  greatly 
over  a  too  great  prominence  of  the  baby's  ears.  Probably 
little  alteration  in  the  shape  can  be  accomplished  in  most 
instances,  and  it  is  better  not  to  meddle  with  them.  A 
cap  or  a  network  bandage  may  be  worn  during  sleep,  to 
keep  the  ears  from  being  bent  by  the  pillow,  and  to  press 
them  inward  somewhat.  A  slight  operation  may  be 
performed  in  bad  cases  to  bring  the  ears  closer  to  the 
head. 

Deformed  Hands  and  Feet. — Children  are  sometimes 
born  with  siipermtmerary  digits  on  the  hands  or  feet,  or 
with  webbing  of  skin  between  the  fingers  or  toes  similar 
to  that  seen  in  a  duck's  foot.  Any  operation  required 
should  be  done  early. 

Club-foot  is  a  distorted  shape  of  the  foot,  in  which, 
most  commonly,  the  front  part  of  the  foot  is  turned  in- 
ward and  the  heel  is  raised.  Sometimes  there  occur  con- 
tractions of  the  foot  into  other  forms.  The  condition 
may  be  present  at  birth  or  may  be  acquired.  Treatment 
should  begin  immediately  and  be  persevered  with.  The 
application  of  a  splint  or  of  some  apparatus  and  the 
frequent  manipulation  of  the  foot  will  effect  a  cure   in 


THE   SICK  BABY. 


299 


many  cases.     In  others  there  must  be  an  operation  as 
welL 

^''  Pigcoii-locd^''  is  the  name  applied  to  the  inward  rota- 
tion of  the  legs  in  walking.  It  is  the 
natural  condition  in  early  childhood, 
and  usually  disappears  with  time  and 
training.  It  is  important  to  be  sure, 
however,  that  it  does  not  depend  on 
the  presence  of  bow-legs  or  club-foot. 
Occasionally  in  simple  pigeon-toe  a 
shoe  or  other  apparatus  is  required  to 
keep  the  toes  turned  out,  but  this 
can  be  fitted  properly  by  a  surgeon 
only  (Fig.  70). 

Ingf'otving  toe-nail  is  a  condition 
in  which  the  edge  of  the  nail,  usually 
of  the  great  toe,  is  pushed  into  the  flesh,  which  rises  above 
it.  It  will  not  often  develop  if  the  shoes  have  been  made 
of  proper  size  and  shape  and  the  toe-nails  have  been  cut 
according  to  the  directions  previously  given.  Should  the 
deformity  be  already  present,  a  small  quantity  of  cotton 
should  be  packed  under  the  corner  of  the  nail,  in  order 
to  raise  it  above  the  flesh.  The  nail  must 
be  cut  square  or,  still  better,  concave  across, 
with  a  notch  in  the  centre  (Fig.  71),  and 
should  also  be  scraped  thin  down  the  mid- 
dle with  the  edge  of  a  knife.  The  corners 
should  never  be  rounded  off".  If  the  disease 
has  advanced  too  far  for  this  plan  of  treat- 
ment, the  advice  of  a  physician  must  be  had. 


Fig.  70.  —  i  igeon-toed. 


Fig.  71. — 
Method  of  cut- 
ting an  ingrow- 
ins  toe-nail. 


Bow-legs  ;  Knock-knee. — These  two  conditions  (Figs. 
72  and  73),  one  the  opposite  in  appearance  of  the  other, 
are  generally  dependent  upon  rickets  combined  with  the 


30O 


THE    CARE    OF  THE   BABY. 


allowing  of  the  child  too  soon  to  bear  its  weight  upon  its 
feet.  Not  infrequently  the  application  of  too  thick  a  diaper 
after  the  child  begins  to  walk  produces  bow-legs  by  forcing 
the  thighs  apart.     Keeping  the  child  off  its  feet  as  much 


Fig.  72. — Bow-legs. 


Fig.  73. — Knock-knee. 


as  possible,  the  persistent  use  of  massage,  and,  in  the  case 
of  bow-legs,  the  use  several  times  a  day  of  gentle  pressure 
with  the  hands  in  a  manner  tending  to  straighten  the 
curve  will  often  in  the  long  run  be  effectual.  There  is 
a  natural  tendency  for  the  bowing  to  disappear  as  the 
child  grows  older,  but  as  the  matter  is  an  important  one 
the  advice  of  a  physician  should  always  be  obtained. 

Hip-joint  Disease. — A  tubercular  inflammation  of  the 
hip-joint,  the  results  of  which  are  so  serious  that  every 
mother  should  be  on  the  alert  to  recognize  its  insidious 
onset.  One  of  the  earliest  symptoms  is  pain,  in  some 
cases  situated  in  the  hip  itself,  but  very  often  felt  only 
in  the  knee.  The  child  is  prone  to  start  suddenly  from 
sleep,   suffering  from  pain.     Very  soon  some  degree  of 


THE   SICK  BABY. 


301 


lameness  comes  011,  lasting  at  first  for  a  few  days  at  a 
time.  The  child  often  tries  to  rest  the  affected  hip  by 
standing  on  the  sound  leg.  Parents  may  make  a  fatal 
mistake  at  this  period  by  attributing  the  symptoms  to  the 
existence  of  "growing  pains"  or  of  weakness  of  the 
knees.  A  physician  should  be  called  in  without  delay, 
for  the  recovery  is  tedious  at  the  very  best.  In  many 
cases  abscesses  form,  and  even  life  is  lost. 

Curvature  of  the  Spine. — There  are  three  forms  of 
this  affection,  very  different  in  nature  and  cause,  which 


Fig.  74. — Lateral  curvature  of  the  spine. 


may  be  mentioned  here.  In  the  first,  called  lateral 
ciirvatnre^  the  spine  makes  an  S-shaped  curve,  as  shown 
by  the  illustration  (Fig.  74).     Rickets  is  the  commonest 


302 


THE    CARE    OE   THE   BABY. 


cause  in  young  children,  while  a  faulty  position  in  sitting 
at  school,  or  the  carrying  of  some  weight  (as  a  baby- 
brother  or  baby-sister)  always  upon  the  one  arm,  produces 
it  in  older  children.  It  is  much  commoner  in  girls  than  in 
bo}S.  ]\Iothers  should  not  fail  to  examine  their  children 
for  the  defect  at  intervals.  The  disease  consists  in  weak- 
ness of  the  articulations  and  muscles,  but  not  of  the 
bones.  The  treatment  must  be  directed  by  a  physician. 
Such  gymnastic  exercises  and  the  assumption  of  such 
positions  are  required  as  will  mechanically  correct  the 
deformity. 


Fig.  75. — Slight  degree  of  curvature  of  the  spine,  from  a  case  of  Pott's  disease. 


The  second  variety  of  curvature,  called  caries  of  the 
spine.,  Potfs  disease.,  or  angular  curvature.,  is  due  to  tu- 
bercular softening  and  destruction  of  the  bones  of  the 
spine,  and  is  of  so  grave  import  that  its  earliest  symp- 


THE   SICK  BABY. 


303 


toms  should  be  reported  to  the  physician.  It  is  rare  before 
the  age  of  two  years.  A  fall  or  blow  seems  sometimes  to 
start  the  process,  but  the  majority  of  cases  are  in  no  way 
due  to  injury.  One  of  the  earliest  symptoms  is  a  pecu- 
liar stiff,  tottering  walk  with  a  tendency  to  fall  forward. 
The  child  moves  the  back  rigidly  and  as  a  whole  in  order 
to  avoid  any  jarring.  It  will  not  bend  the  back  to  pick 
up  anything  from  the  floor,  but  does  it  by  bending  the 
knees.  If  the  trouble  is  higher  in  the  spine,  the  shoulders 
are  sometimes  carried  "shrugged  up"  and  the  neck 
stiflf.  Where  the  disease  is  low  in  the  spine  the  child 
sometimes  has  a  disposition  to  walk  leaning  forward,  with 
the  hands  at  times  upon  the  thighs.  Pain  felt  at  the 
seat  of  trouble  is  usually  pres- 
ent. Karly  in  the  disease  pain 
is  very  often  felt  in  the  abdo- 
men, and  resembles  a  stomach- 
ache caused  by  indigestion. 
Sooner  or  later  there  develops 
a  slight  prominence  of  the  spine 
which  only  a  skilled  eye  may 
detect.  Eventually  the  promi- 
nence becomes  quite  visible 
(Fig.  75),  and  it  may  even  re- 
sult in  great  deformity. 

The  third  form,  the  I'-ickety 
posterior  curvature^  occurs  in 
severe  cases  of  rickets  in  infancy 
(Fig.  76).  It  is  due  to  the  same 
articular  and  muscular  weak- 
ness which  produces  lateral  curvature,  but  it  consists 
of  a  very  long  rounded  curve  extending  posteriorly  and 
occupying  nearly  the  whole  length  of  the  back,  \vhile 
in  Pott's  disease  the  curve  is  at  first  more  angular,  short, 


Fig.  76.- 


-Rickety  curvature  of 
the  spine. 


304  THE    CARE    OF   THE   BABY. 

and  small.     It  will  disappear  when  the  other  symptoms 
of  rickets  are  removed. 

U  Iceration  of  the  Navel. — Instead  of  drying  up  properly 
the  navel  cord  sometimes  becomes  soft  and  ill-smelling  and 
leaves  a  large  ulcer  after  falling  off.  General  blood-pois- 
oning of  the  infant  may  easily  follow  disease  of  the  navel. 
In  some  cases  a  pea-sized  red  protuberance  can  be  detected 
within  the  navel,  and  from  this  comes  a  little  discharge 
which  irritates  the  surrounding  skin.  Frequent  thorough 
dusting  with  a  powder  consisting  of  boric  acid  and  oxide 
of  zinc  (Appendix,  95)  will  often  effect  a  cure  promptly. 
If  not,  the  family  physician  may  have  to  cauterize  the 
ulcer,  or  perhaps  cut  off  the  protuberance. 

Bleeding  from  the  Navel. — Slight  oozing  of  blood 
from  the  navel  is  not  infrequently  seen  after  the  cord  has 
fallen.  It  is  generally  the  result  of  lack  of  gentleness  in 
washing  and  dressing  the  ulcer  which  has  remained.  No 
special  treatment  is  required.  If  the  bleeding  grows 
steadily  greater  in  amount,  the  disease,  fortunately  rare, 
is  a  very  serious  one.  A  sudden  profuse  hemorrhage 
may  be  the  result  of  the  loosening  of  the  ligature, 
or,  later,  the  giving  way  of  a  large  vessel  in  the  navel 
wound.  Firm  pressure  made  between  the  finger  and 
thumb  must  be  maintained  until  the  physician  can  arrive. 

Birth-marks  ;  Mother's-marks. — Under  this  heading 
are  included  both  ncBvi^  as  physicians  call  them,  and 
moles.  A  ikevus  consists  of  a  red  or  purple  patch  on  the 
skin,  sometimes  on  a  level  with  it,  sometimes  elevated 
above  it.  Although  usually  small,  it  is  occasionally  ex- 
tensive, and  in  some  instances  it  is  disposed  to  grow,  and 
may  then  prove  dangerous.     A  mole  is  a  dark  pigmented 


THE   SICK  BABY.  305 

area  in  the  skin,  either  flat  or  elevated,  smooth  or  covered 
with  hair.  It  is  generally  small,  but  sometimes  is  of 
sufficient  size  to  cause  great  disfigurement. 

Contrary  to  the  popular  belief,  birth-marks  are  in  no 
way  dependent  upon  impressions  made  upon  the  mind  of 
the  mother  before  the  child  was  born  (compare  page  25). 
Treatment  can  be  prescribed  only  by  a  physician.  Cau- 
terization or  some  more  serious  operation  may  be  needed, 
and  some  birth-marks  cannot  be  removed  at  all. 

Warts.— These  disfiguring  growths  are  most  common 
in  children.  They  are  apt  to  develop  rapidly,  and  often  to 
disappear  quite  as  quickly  without  treatment.  There  is 
no  good  evidence  that  charms  have  any  curative  value 
whatever,  and  most  of  the  applications  recommended  are 
equally  useless.  The  warts  are  best  let  alone  or  cauter- 
ized by  a  physician. 

Red  Gum  ;  Strophulus. — Titles  formerly  applied  to  a 
red,  pimply  eruption  from  which  babies  often  suffer 
during  the  first  weeks  of  life.  The  rash  is  generally 
either  eczema  or  prickly  heat. 

Prickly  Heat;  Miliaria. — A  very  common  affection  in 
infants,  consisting  of  an  eruption  of  numerous  minute 
red  elevations  (papules),  or  of  pinhead-sized,  inflamed 
blisters  (vesicles),  or  of  both  together  (see  page  318). 
These  are  closely  crowded,  particularly  where  there  is 
much  perspiration,  as  about  the  neck  and  over  the  trunk. 
The  disease  begins  very  suddenly  and  is  attended  by  more 
or  less  burning  and  tingling,  but  seldom  by  the  very  in- 
tense itching  of  eczema.  The  latter  affection,  moreover, 
usually  develops  more  slowly  and  its  vesicles  show  a 
greater  tendency  to  run  together.  Prickly  heat  is  seen 
20 


306  THE    CARE    OE   THE   BAElV. 

chiefly  in  hot  weather,  and  especially  in  children  who  are 
too  warmly  clothed  and  who  perspire  profnsely  as  a  resnlt 
of  this.  Treatment  consequently  consists  chiefly  in 
avoiding  or  remo'v'ing  the  cause.  The  clothing  must  be 
made  as  cool  as  the  child  can  wear  with  entire  safety. 
It  is  particularly  in  children  disposed  to  prickly  heat  that 
woollen  underclothing  must  sometimes  be  replaced  in 
summer  by  cotton  material  (see  p.  88).  The  irritated 
skin  may  be  dusted  with  a  camphor-and-zinc  powder 
Appendix,  94)  and  the  child  given  a  laxative  alkaline 
mixture  (Appendix,  106)  or  a  dose  of  magnesia  and  a 
light  diet.  Sometimes  the  itching  is  relieved  by  a  solu- 
tion of  a  teaspoonful  of  baking-soda  in  a  pint  of  water 
dabbed  on  and  allowed  to  dry.  If  recovery  does  not 
follow  in  a  very  few  days,  a  physician's  advice  should 
be  obtained. 

Eczema. — A  troublesome  disease,  particularly  common 
in  infants,  lasting  days,  months,  or  occasionally  even 
years,  and  limited  to  a  large  or  a  small  area,  or,  in  rare 
instances,  covering  the  entire  body.  The  special  tend- 
ency to  suffer  from  it  disappears  in  most  cases  by  the 
end  of  the  first  year,  although  it  is  frequent  at  all 
periods  of  life.  Among  the  princij^al  causes  are  inherited 
tendency,  debilitated  constitution,  imperfect  hygiene,  im- 
proper diet  (particularly  in  infants  the  early  use  of 
starchy  food),  digestive  disturbances,  free  perspiration, 
irritating  soap,  the  contact  of  soiled  diapers,  any  other 
local  irritation,  etc.  Often  no  cause  can  be  discovered. 
The  commonest  situations  are  about  the  head,  the 
crotch,  the  groins,  and  the  folds  of  the  joints  in  gen- 
eral. In  the  most  frequent  form  the  skin  becomes  bright 
red  and  covered  with  minute,  pinhead-sized  vesicles. 
These  soon  rupture,  leaving  the  surface  swollen,  red,  and 


THE   SICK  BABY.  307 

moistened  with  a  watery  discharge  which  may  thicken 
and  form  crusts  with  raw  flesh  beneath.  In  another 
form  the  skin  is  dry,  red,  thickened,  and  somewhat 
scaly,  and  perhaps  cracks  easily.  In  still  another  com- 
mon variety  numerous  small  pustules  develop;  while 
in  another  the  eruption  is  chiefly  composed  of  papules 
(see  p.  318).  The  attack  is  attended  by  itching  which  is 
often  so  intense  that  the  child  is  nearly  frantic.  This  is 
generally  worse  at  night,  and  may  prevent  sleeping. 
Owing  to  the  disposition  of  the  rash  to  spread,  every 
case  should  early  be  put  under  a  physician's  care.  The 
treatment  open  to  the  mother  is  to  remove  the  cause  if  it 
can  be  found.  Besides  this  she  may  give  a  laxative  at 
the  outset,  reduce  the  quantity  and  the  strength  of  the 
food,  hinder  scratching  by  putting  the  hands  into  mittens 
or  even  by  fastening  them  to  the  sides,  prevent  any 
friction  of  the  skin  from  rough  clothing,  cease  to  employ 
soap,  use  no  more  water  on  the  diseased  part  than  is 
absolutely  necessary,  and  employ  a  lotion  of  starch  and 
boric  acid  instead  of  plain  water  for  cleansing  (Appen- 
dix, 83).  The  skin,  if  red  and  weeping,  may  be  dusted 
frequently  with  a  drying  powder  (Appendix,  96).  Sur- 
faces which  touch  each  other  must  be  separated  by 
placing  between  them  a  thin  layer  of  absorbent  cotton 
or  patent  lint  well  filled  with  the  powder.  Soaking  in 
sweet  oil   may  be  employed  to  remove  any  crusts. 

Hives;  Nettle-rash;  Urticaria. — Few  or  numerous 
distinct  raised  blotches,  pinkish  or  whitish  in  color,  and 
of  a  size  which,  although  having  a  considerable  range, 
averages  that  of  the  finger-nail.  They  often  resemble 
closely  the  elevations  produced  by  the  stings  of  insects. 
A  crop  of  hives  comes  out  with  great  suddeness,  lasts 
a  few  hours  or  a  day,  and  is  then,  perhaps,  succeeded  by 


30S  THE    CARE    UE   THE   BABY. 

another,  the  whole  attack  persisting  for  two  or  three  days 
or  sometimes  becoming  chronic.  The  burning  and  ting- 
ling are  often  intense.  The  commonest  cause  is  some 
disturbance  of  digestion.  Sometimes  one  certain  article 
of  diet  will,  without  affecting  the  digestion,  always  pro- 
duce nettle-rash  in  one  child,  and  another  article  will 
have  the  same  effect  in  another  child.  Among  the  foods 
most  apt  to  act  in  this  way  are  fish,  shell-fish,  straw- 
berries, pineapples,  mushrooms,  and  sausages.  Some- 
times the  presence  on  the  skin  of  a  single  insect,  as  a 
hairy  caterpillar  or  a  flea,  may  bring  out  a  large  crop  of 
hives.  Contact  with  the  stinging-nettle  or  with  the  jelly- 
fish may  produce  the  rash.  The  treatment  usually  effi- 
cacious for  mild  cases  consists  in  giving  a  dose  of  mag- 
nesia followed  by  "a  laxative  alkaline  mixture  (Appendix, 
io6)  and  reducing  the  diet  temporarily.  The  skin  may 
be  powdered  frequently  with  camphor-and-zinc  powder 
(Appendix,  94),  or  the  spots  dabbed  with  absorbent  cotton 
wet  with  equal  parts  of  vinegar  and  water  or  with  a 
special  cooling  lotion  (Appendix,  89).  In  cases  which 
tend  to  be  chronic  or  to  recur  frequently  the  great  aim 
must  be  to  search  for  and  remove  the  cause.  Starch-and- 
soda  baths  (Appendix,  48)  often  do  great  good,  but  the 
disease  ought  to  be  treated  by  a  physician  if  it  lasts  more 
than  a  few  days,  as  it  is  sometimes  most  difficult  to  cure 

Chafing;  Cracks;  Roughness  of  the  Skin;  Chap- 
ping.— Chafing  may  occur  wherever  two  moist  surfaces  of 
skin  are  constantly  touching  each  other.  It  is  common 
in  the  folds  of  the  neck  in  fat  babies,  in  the  armpits,  and 
about  the  buttocks,  thighs,  and  groins.  In  the  latter 
localities  it  is  liable  to  be  produced  by  a  too  infrequent 
changing  of  diapers,  particularly  if  there  is  an  acid  diar- 
rhoea.    When  the  attack  is  severe  the  skin  is  bright  red, 


THE   SICK  BABY.  3O9 

tender,  moist,  and  looks  almost  raw.  In  children  dis- 
posed to  it  the  disease  may  be  prev-ented  by  ensnring 
great  cleanliness  and  by  the  nse  of  starch-water  for  wash- 
ing, followed  by  a  thorough  drying  and  dusting  with  a 
talc  powder.  When  there  is  diarrhoea,  the  free  applica- 
tion of  vaseline  helps  to  keep  the  skin  from  becoming 
moist.  To  cure  chafing  already  present  the  methods 
mentioned  must  be  followed,  and,  in  addition,  pieces  of 
lint  previously  dusted  with  an  astringent  powder  (Ap- 
pendix, 96)  should  be  placed  in  the  folds  between  the 
affected  surfaces. 

Cracks  are  generally  produced  in  the  same  way  as 
chafing,  and  are  in  reality  of  the  same  nature.  Those  in 
the  folds  of  the  neck  are  sometimes  very  difficult  to  heal. 
The  frequent  application  of  a  hot  wet  sponge  followed  by 
careful  drying  may  be  of  benefit. 

A  general  roughness  of  the  skin  is  generally  best  treated 
by  thorough  rubbing  with  olive  oil  or  vaseline  after  bathing. 

Chapping  of  the  hands  and  face  usually  results  from 
exposure  to  cold.  It  is  best  prevented  by  protecting 
with  veil  and  gloves.  The  treatment  is  much  the  same 
as  for  roughness  of  the  skin. 

Stomach-rash  ;  Tooth-rash. — Terms  often  used  by 
mothers  to  designate  many  sorts  of  rashes  seen  in 
infants.  They  are  more  properly  applied  to  an  erup- 
tion of  erythema.^  that  is,  of  a  diffuse  redness  or  of  dis- 
tinct, pea-sized,  scarcely  elevated  spots  which  appear 
very  suddenly,  last  a  few  hours  or  da}'s,  and  produce  no 
irritation.  This  often  develops  in  infants  suffering  from 
some  digestive  disturbance.  Treatment  is  generalh'  not 
required,  other  than  that  for  the  indigestion. 

Boils  and   other  Pustular  Eruptions. — In  a  strictly 


310  THE   CARE    OF   THE   BABY. 

medical  sense,  a  boil,  or  funinch\  consists  of  an  elevated 
rounded  or  conical,  dusky-red,  painful,  and  very  tender 
swelling  which  contains  pus.  When  it  bursts  it  is  found 
to  have  a  distinct  "core"  of  dead  tissue.  Furuncles 
may  be  single,  but  are  very  apt  to  occur  several  at  a 
time  and  in  successive  crops.  Impairment  of  the  gen- 
eral health  or,  in  babies  especially,  chronic  digestive  dis- 
turbance causes  them  in  many  cases,  but  some  children 
have  a  peculiar  predisposition  to  them,  although  ap- 
parently well  in  other  respects.  The  disease,  however, 
is  never  a  sign  of  robust  health,  as  has  sometimes  been 
supposed. 

There  are  various  other  pustular  eruptions  which  are 
popularly  known  as  "boils,"  but  which  are  named 
otherwise  by  physicians.  Some  of  these  are  the  result 
of  most  unfavorable  hygienic  conditions;  others  are  evi- 
dences of  eczema;  others  occur  entirely  independently  of 
any  affection  of  the  general  health  or  digestion  ;  others 
constitute  a  peculiar  acute  contagious  disease  ;  and  still 
others  are  the  result  of  syphilis.  The  only  treatment  of 
pustular  eruptions  which  is  justifiable  without  the  advice 
of  a  physician  is  the  protecting  of  the  affected  parts  or 
the  smearing  them  with  a  little  pure  ichthyol.  Poultices 
must  never  be  applied  unless  ordered.  When  used,  they 
should  be  mixed  with  a  boric-acid  solution  (Appendix, 
79)  instead  of  with  plain  water,  or,  still  better,  the  dress- 
ing should  be  the  antiseptic  poultice  described  later  (Ap- 
pendix, 66).  Tonic  treatment  and  change  of  air  are 
needed  in  many  cases. 

Fever-blisters. — Small  groups  of  minute,  closely- 
crowded  blisters  (vesicles,  see  p.  318)  which  contain  a 
clear  watery  fluid,  and  which,  if  not  ruptured,  dry  into  a 
crust.     In  many  children   slight  fever,  such  as   accom- 


THE  SICK  BAB  V.  3 1 1 

panics  a  cold  or  indigestion,  will  invariably  prodncc 
tlieni.  They  arc  generally  sitnated  on  the  lips  or  the 
edges  of  the  nose,  although  in  bad  cases  they  may  spread 
over  the  face  or  below  the  chin.  The  spots  should  be 
smeared  twice  a  day  with  pure  ichthyol  or  with  a  zinc- 
and-bismuth  ointment  (Appendix,  72). 

Dandruff;  Milk-crust. — Young  babies  often  show  a 
tendency  to  an  excessive  production  of  oily  scales  upon  the 
head.  Unless  carefully  watched,  these  will  accumulate 
in  large  yellowish  patches  commonly  known  as  "  ;?2z7y^- 
criist.''''  Some  mothers  have  a  mistaken  notion  that 
this  should  be  carefully  let  alone.  Great  cleanliness  will 
prevent  any  such  accumulation,  and  rubbing  the  head 
daily  with  a  boric-acid  ointment  (Appendix,  74)  will 
often  check  the  excess  of  oily  secretion.  A  patch  already 
formed  should  be  removed  by  soaking  it  with  warm  olive 
oil  and  then  washing  it  with  Castile  soap  and  warm 
water.  A  fine-tooth  comb  should  never  be  used  on  it. 
When  the  patch  is  found  to  have  a  raw,  weeping  surface 
beneath  it,  it  is  not  simply  milk-crust,  but  eczema,  and 
should  be  treated  accordingly. 

In  older  children  there  is  often  a  production  of  dryer 
scales,  or  dandruffs  which  are  without  the  very  oily  cha- 
racter, and  which  consequently  fly  about  when  the  hair 
is  brushed.  The  scalp  should  be  washed  frequently  with 
water  and  one  of  the  German  salicylic-acid  or  sulphur 
superfatted  soaps.  If  dandruff  persists,  a  physician  must 
be  consulted,  since  falling  of  the  hair  may  follow. 

Ringworm. — h.  common  and  very  contagious  affection, 
due  to  a  microscopic,  mould-like,  fungous  growth.  On  the 
face  and  body  it  occurs  much  more  frequently  in  child- 
hood than  later,  and  on  the  scalp  it  is  found  at  this  time 


312  THE    CARE    OF   THE   BABY. 

of  life  only.  In  the  former  situation  it  consists  of  a  single, 
dull-red,  more  or  less  circular  spot,  which  graduall)-  en- 
larges into  a  patch  with  a  red,  somewhat  scaly  border  and 
a  paler,  more  natural  centre.  This  ring-like  shape  gives 
the  name  to  the  disease.  On  the  scalp,  which  is  by  far 
the  commonest  situation,  the  patches  are  numerous,  cir- 
cular, and  little,  if  at  all,  red.  The  hair  comes  out, 
leaving  the  spots  more  or  less  bald,  and  often  covered  with 
fine  scales  and  with  short  brittle  stumps  of  broken  hairs 
which  can  be  pulled  out  easily.  This  latter  is  a  charac- 
teristic symptom. 

The  cure  of  ringworm  of  the  scalp  is  so  difficult  and 
so  tedious  at  the  best  that  no  mother  should  dream  of 
undertaking  it.  Her  province  is  to  follow  directions 
carefully  and  to  see  that  other  children,  her  own  as  well 
as  those  of  other  people,  do  not  catch  it.  The  affected 
child  must  on  no  account  be  sent  to  school,  and  all 
its  toilet  articles  must  be  kept  strictly  for  its  own  use. 
Some  sort  of  skull-cap  may  be  worn  to  prevent  the  germs 
from  getting  about.  The  sooner  a  physician  sees  the 
case  the  greater  the  chance  of  getting  it  under  control. 

Ringworm  of  the  body  is  much  more  easily  cured.  An 
ointment  such  as  that  given  in  the  Appendix  (73)  may  be 
rubbed  into  the  spot  twice  a  day  for  a  week  or  longer; 
but  here,  too,  a  wise  mother  will  not  undertake  the  care 
of  the  case  herself. 

Itch  ;  Scabies. — An  intensely  itching  and  very  con- 
tagious affection  of  the  skin,  due  to  the  presence  of  a 
minute  insect  which  burrows  under  the  surface.  The 
disease  may  attack  any  age  from  infancy  up.  Although 
commonest  among  the  poor  and  dirty,  it  may  by  contact 
with  them  be  contracted  by  the  cleanest  child.  Exam- 
ination shows  scattered,   small  pimples,  which  may  oc- 


THE   SICK  BABY.  313 

cupy  any  part  of  the  body,  but  which  are  usually  first 
found  on  the  sides  of  the  fingers.  The  toes,  armpits, 
buttocks,  and  the  central  parts  of  the  body  are  also 
favorite  seats.  Sometimes  a  few  irregularly  shaped 
ridges,  one  to  ten  lines  long,  show  themselves  here  and 
there  and  make  the  diagnosis  certain.  They  are  the  bur- 
rows in  which  the  female  insect  lays  her  eggs.  Often, 
however,  the  itching  is  so  intense,  and  the  skin  so  irri- 
tated and  torn  by  the  scratching  which  this  incites,  that 
the  original  characteristic  appearance  is  destroyed  and 
the  diagnosis  may  be  difficult.  If  several  children  of  one 
family,  and  perhaps  the  parents  as  well,  are  suffering 
from  an  itching  eruption,  it  is  pretty  certain  that  the 
disease  is  the  itch.  Treatment  is  almost  beyond  the 
power  of  the  mother,  for  the  applications  necessary  some- 
times produce  decided  irritation  which  must  be  checked. 
As  contagion  takes  place  by  the  clothing  and  the  bed- 
linen,  particular  attention  must  be  given  to  their  disin- 
fection. 

Lice ;  Pediculi. — Although  these  little  insects  are  by 
right  the  inhabitants  of  the  unwashed,  any  child,  no 
matter  how  clean,  may  be  infected  by  them  through  some 
accidental  contact  with  another.  When  once  in  posses- 
sion, they  are  not  killed  by  the  simple  washing  of  the 
head  with  soap  and  water.  The  first  symptom  is  a  very 
decided  itching  of  the  scalp.  The  scratching  which  this 
causes,  and  the  irritation  by  the  animals  themselves,  set 
up  an  inflammation,  and  produce  pustules  and  matting 
of  the  hair  if  the  case  is  severe.  Eczema  situated  at  the 
back  of  the  head  is  in  most  cases  the  result  of  the  pres- 
ence of  lice.  Careful  inspection  shows  the  minute  oval 
eggs  ijiits)  attached  by  one  end  to  the  hairs.  The  careful 
use  of  a  fine-tooth  comb  will  probably  remove  some  of 
the  animals  themselves.     Many  different  applications  are 


314  THE   CARE    OE   THE   BABY. 

equally  serviceable,  but  some  of  them  are  quite  irritating. 
One  of  the  safest  and  most  popular  is  the  ointment  of 
stavesacre  (larkspur-seeds),  which  should  be  rubbed  upon 
the  scalp  several  days  in  succession.  Kerosene  is  also  a 
good  application,  but  must  not  be  applied  near  a  flame 
of  any  sort.  The  hair  meanwhile  should  be  washed  re- 
peatedly with  vinegar  in  order  to  destroy  the  nits.  With 
proper  care  long  hair  need  not  be  cut. 

There  is  one  species  of  lice — body-lice — which  infests 
the  clothing  only.  The  remedy  consists  in  entire  de- 
struction or  baking  of  the  infested  garments  and  the 
placing  of  the  child  in  a  disinfectant  bath  (Appendix, 

102). 

(5)   INFECTIOUS   DISEASES. 

Of  the  numerous  infectious  diseases,  we  may  consider 
typhoid  fever,  small-pox,  chicken-pox,  vaccination, 
scarlet  fever,  measles,  German  measles,  erysipelas,  diph- 
theria, mumps,  whooping-cough,  and  influenza.  Certain 
other  diseases  which  are  known  to  be  infectious,  such  as 
rinsfworm,  and  others  which  are  now  believed  to  be  so 
without  much  doubt,  such  as  pneumonia  and  rheumatism, 
are  considered  in  other  sections  for  the  sake  of  conve- 
nience. 

They  are  called  infectious  because  due  to  microscopic 
germs  which  are  capable  of  being  transmitted  from  per- 
sons with  the  disease  or  from  other  sources  and  of  infect- 
ing the  system  of  others.  Most  of  these  are  contagious 
as  well  as  infectious.  Malaria  is  an  instance  of  one  which 
is  infectious  because  due  to  a  microscopic  germ,  but  which 
is  not  contagious,  because  it  cannot  be  contracted  from 
another  person.  All  the  diseases  enumerated  in  the  open- 
ing lines  of  this  section  are  both  contagious  and  infectious. 
The  infection  maybe  by  direct  contact,  or  the  germs  may  in 
some  cases  be  carried  by  another  person  or  by  water,  food, 


THE   SICK  BAB  Y.  3 1  5 

clothing,  books,  letters,  etc.  The  gerins  of  some  of  the 
diseases  have  a  great  tenacity  of  life.  A  case  of  con- 
tagions disease  is  always  the  resnlt  of  some  other  case 
from  which  the  contagion  conies,  even  though  we  are 
not  able  to  trace  the  connection.  All  of  the  diseases 
mentioned,  with  the  possible  exception  of  whooping- 
cough,  are  accompanied  by  more  or  less  fever.  Some  of 
them  are  called  eruptive  fevei^s^  because  there  is  a  cha- 
racteristic eruption  or  r-ash  upon  the  skin.  Treatment  is 
entirely  the  province  of  a  physician.  There  is  absolutely 
no  way  known  to  avoid  contracting  them  except  by 
keeping  away  from  the  contagion.  The  carrying  of 
disinfectants  about  the  body,  such  as  bags  of  camphor  or 
carbolized  substances,  is  entirely  useless.  The  recogni- 
tion of  the  existence  of  one  of  the  infectious  diseases  is 
beyond  the  mother's  skill  in  many  instances,  while  in 
others  it  is  comparatively  easy.  The  table  which  fol- 
lows gives  in  convenient  form  information  regarding 
these  diseases,  which  will  be  of  value  to  a  mother  de- 
sirous of  understanding  something  of  their  nature. 

Physicians  use  certain  terms  as  applied  to  infectious 
diseases,  which  may  conveniently  be  described  in  this 
connection.  The  day  of  the  disease — as  the  "  first  day  " 
or  the  "third  day" — is  in  accord  with  the  ordinary 
method  of  dividing  time,  and  does  not  indicate  the  num- 
ber of  times  twenty-four  hours  have  elapsed  since  the 
symptoms  first  appeared.  Thus,  if  the  onset  of  symp- 
toms occurred,  for  instance,  at  10  p.  m.  on  Tuesday  the 
14th,  the  "second  day  of  the  disease"  does  not  begin 
with  10  P.  M.  on  the  15th,  but  is  counted  from  midnight 
of  the  14th — the  time  when  Wednesday  the  15th  begins, 
although  this  is  only  two  hours  after  the  onset.  The 
stage  of  incubation  denotes  the  period  which  elapses 
between  exposure  to  contagion  and  the  appearance  of  the 


3i6 


THE   CARE    OF  THE   BABY. 

TABLE  OF  INFEC 


Disease. 

Date  of 

r„„,  K-,.-„„           Characteristic 
Incubation         c    „    .   _  r    „ 
Instc              i  Symptom  from 
'^'^~                bfginning  of 
1        Invasion. 

Characteristic  Symptom. 

Typhoid 
fever. 

About  14  days. 

7th  or  8th  day. 

Rose-red,  .slightly  elevated  spots. 

S'carlet 
fever. 

I  to  7  days. 

1st  or  2d  day. 

Intense,  bright  -  red  blush  over 
body. 

Measles. 

12  to  14  days. 

4th  day. 

Dusky  or  purplish  -  red,  slightly 
elevated  spots,  scattered  and  in 
characteristic  groupings. 

German 
measles. 

7  to  21  days. 

1st  day. 

Pale,  rose-red  six)ts  or  uniform 
blush;  no  characteristic  group- 
ings. 

Chicken-pox. 

13  to  17  days. 

1st  day. 

Pea-sized,  scattered  vesicles. 

Varioloid 
(Variola). 

10  to  14  days. 

3d    day    (may 
be  1st  or  2d). 

Red,  elevated  papules  ;  then  ves- 
icles;   then  often  pustules.         1 

Vaccinia 
(Vaccina- 
tion). 

Erysipelas. 

I  to  2  days. 

1st     day     (3d 
after   vacci- 
nation). 

A  red  papule,  becoming  a  vesicle 
and  then  a  pustule;  surroundedl 
by  a  broad  red  area. 

3  to  7  days. 

1st  or  2d  day. 

Bright-red  blush ;  puffy  skin  ;  often 
blisters. 

Diphtheria. 

2  to  12  days. 

1st  or  2d  day. 

White  membrane  on  tonsils  and 
other  parts  of  throat. 

Whooping- 
cough. 

2  to  7  days. 

7th     to     14th 
day. 

A  prolonged  paroxysm  of  cough- 
ing followed  by  a  crowing  in- 
spiration  (whoop). 

Mumps. 

7  to  21  days. 

1st  day. 

Swelling  in  front,  below,  and  be- 
hind the  ear  and  below  the  jaw. 

Influenza. 

Uncertain. 
Probably     i 
to  7  days. 

1st  day. 

Fever,  prostration. 

first  symptoms.  The  stage  of  invasion  is  the  time  fol- 
lowing incubation,  in  which  there  are  distinct  evidences 
of  illness,  although  the  characteristic  symptom  (such 
as  the  eruption  in  measles  or  the  whoop  in  whooping- 
cough)  has  not  appeared.     Symptoms  seen  during  this 


THE  SICK  BABY. 

TIOUS  DISEASES. 


317 


Other  Principal  Symptoms. 

Whole  Duration 
of  Disease 
from  Onset. 

Quarantine  lasts 
from  Onset — 

Apathy ;     dianhciea ;     nose  -  bleed  ; 
headache. 

2  to  4  weeks. 

While  disease  lasts. 

Sore    throat;    often    vomiting    with 
onset. 

7  to  9  days  or  more 
(not  including  des- 
quamation). 

6  weeks  at  least. 

Cold     in     head;      running     eyes; 
cough ;    hoarseness. 

7  to  8  days. 

3  weeks. 

Slight  sore  throat ;    slight  running 
of  eyes  and  nose. 

3  to  4  days. 

3  weeks. 

None ;  or  slight  fever. 

A  week  or  less. 

3  to  4  weeks. 

Headache ;  backache ;   vomiting. 

About  14  days. 

4  to  8  weeks. 

Often  feverishness  and  malaise. 

About  3  weeks. 

None. 

Fever;  pain. 

4  to  6  days,  or  several 
weeks  if  it  spreads. 

Averages  2  weeks. 

Debility;  fever. 

10  to  14  days. 

3  to  4  weeks. 

Vomiting;  spitting  of  blood. 

6  to  8  weeks 

6  to  8  weeks,   (while 
whoop    lasts). 

Pain  Wfhen  chewing. 

A  week  or  less. 

3  to  4  weeks. 

Various    respiratory,    digestive,    or 
nervous     symptoms,     commonest 
being  general  acliing  and  cough. 

3    or  4   days  to   two 
weeks  or  more. 

While  disease  lasts. 

period  are  called  prodro7nal  or  mitial.  The  first  day  of 
invasion  marks  the  onset  of  the  disease,  and  from  this 
day  the  duration  of  the  disease  is  dated.  Next  comes 
the  stage  of  characteristic  symptoms  called  the  eruptive 
stage  in   the  case  of  eruptive   fevers.      Sometimes  the 


3l8  THE   CARE    OE   THE   BABY. 

invasion  lasts  less  than  a  day,  as,  for  instance,  in  chicken- 
pox,  and  the  characteristic  symptoms  then  appear  on  the 
first  day  of  the  disease;  that  is,  there  is  no  evident  stage 
of  invasion.  Desqiiamation  is  the  shedding  of  the  skin 
which  follows  in  some  of  the  fevers.  The  duration  of  the 
contagiousness,  throughout  which  the  child  should  be 
kept  from  mingling  with  others,  is  sometimes  called  the 
period  of  qiiaj-ajitiiie  or  of  isolation. 

Certain  other  terms  are  used  in  speaking  of  some  of  the 
eruptive  fevers  and  of  certain  skin  diseases.  A  vesicle  is 
a  little  elevated  blister,  the  size  of  a  split  pea  or  smaller, 
filled  with  a  clear,  watery  fluid.  A  macule  is  a  small  red 
spot  not  elevated  above  the  skin.  A  papule  is  a  red, 
pimple-like  elevation.  A  pustule  is  shaped  like  a  papule 
or  a  vesicle,  but  contains  pus. 

The  following  is  a  much  abbreviated  review  of  the 
infectious  diseases,  supplementary  to  the  table  and  con- 
taining chiefly  facts  not  mentioned  there.  The  special 
nursing  required,  particularly  as  regards  disinfection  of 
the  room,  clothing,  etc.,  is  described  in  discussing  the 
Trained  Nurse  and  the  Sick  Room  in  Chapters  IX.  and 
X.  The  final  disinfection  of  the  child  is  accomplished 
by  a  disinfectant  bath  (Appendix,  102). 

Typhoid  Fever. — Somewhat  less  often  seen  in  children 
than  in  adults,  and  less  severe  ;  less  common  under  three 
years  of  age,  yet  developing  not  infrequently  in  infants 
under  a  year  ;  occurring  oftenest  in  autumn.  It  is  but 
slightly  contagious,  for  it  is  transmitted  only  by  the 
germs  from  the  bowel-movements  contaminating  the 
drinking-water  or  the  food  of  others.  As  a  rule,  one 
attack  protects  from  subsequent  ones.  Symptoms  of 
invasion  begin  very  insidiously  in  children  with  debility, 
loss  of  appetite,   fever,   often  vomiting,   nose-bleed,  and 


THE   SICK  BABY.  319 

occasionally  diarrhoea.  The  last  symptom  is  much  less 
frequent  than  in  adults.  Sometimes,  esjDecially  in  chil- 
dren, the  onset  is  much  more  sudden.  The  fever  gradu- 
ally increases  for  a  week,  then  stays  high  (103°  to  104°) 
for  a  week  or  two,  but  with  a  very  characteristic  differ- 
ence between  the  morning  and  evening  temperatures,  and 
then  gradually  diminishes.  Very  frequently  children 
scarcely  feel  sick  at  all,  and  the  disease  in  them  may 
stop  much  short  of  the  usual  three  or  four  weeks.  Nearly 
always  there  are  a  peculiar  apathy  and  somnolence  present. 
In  some  cases,  however,  especially  in  children,  there  is 
an  unusual  degree  of  wild  delirium,  and  meningitis  is 
suspected.  The  characteristic  rose  spots  may  be  only 
few  or  may  be  very  numerous.  They  are  found  chiefly 
on  the  trunk,  and  especially  on  the  abdomen,  come  in 
successive  crops,  and  continue  to  appear  until  the  disease 
is  nearly  over.  They  are  slightly  elevated,  oval,  rose- 
red,  and  about  one-sixth  of  an  inch  long,  and  disappear 
momentarily  when  pressed  upon.  Inflammation  in  the 
bowel  is  always  present,  and  ulcers  are  liable  to  form  ; 
and  if  the  thin,  paper-like  wall  of  one  of  these  ulcers  per- 
forates, death  almost  certainly  follows  in  a  few  hours. 
We  can  easily  see,  then,  the  tremendous  importance  of 
very  soft  food,  especially  milk,  and  of  absolute  rest  in 
bed  and  the  use  of  a  bed-pan,  no  matter  how  slightly  sick 
the  child  may  seem.  Yet  the  danger  of  perforation  is 
very  much  less,  especially  in  quite  young  children,  than 
it  is  in  adult  life.  Since  the  germs  are  contained  in  the 
passages  only,  these  should  be  covered  as  soon  as  passed, 
and  be  disinfected  promptly  (Appendix,  98).  The  bed- 
linen  and  bed-clothes  also  ought  to  be  disinfected. 

Scarlet  Fever;  Scarlatina;  Scarlet  Rash. — The  dif- 
ferent names  mean  exactly  the  same.     The  disease  is  one 


320  THE    CARE    OF  THE   BABY. 

of  tlie  commonest  affections  of  children,  occurs  at  any 
time  of  year,  is  rare  mider  the  age  of  one  year  and  espe- 
cially under  that  of  six  months,  and  is  very  contagious, 
yet  less  so  than  measles.  The  germs  are  generally  be- 
lieved to  be  transmitted  especially  by  the  skin,  and  can 
be  carried  in  the  clothing  from  the  sick  to  the  well. 
Their  vitality  is  remarkable,  for,  attached  to  some  gar- 
ment, they  may  live  for  months.  A  second  attack  is  of 
great  rarity,  for  in  nearly  every  supposed  instance  of  it 
the  child  really  had  some  unrecognized  rash  on  one  of  the 
occasions.  The  disease  may  be  so  mild  that  it  is  over- 
looked, or  so  severe  that  the  child  dies  in  a  few  hours. 
The  lightest  case  is  capable  of  giving  the  most  severe 
form  to  other  children.  In  a  case  of  average  severity  the 
first  symptoms  are  vomiting,  fever,  rapid  pulse,  and  sore 
throat.  The  rash  appears  within  twenty-four  hours, 
usually  first  about  the  neck,  and  rapidly  spreads  over  the 
whole  body,  although  generally  less  developed  on  the 
face  than  elsewhere,  particularly  around  the  mouth. 
It  consists  of  minute  red  points,  not  at  all  elevated,  and 
so  closely  crowded  that  the  skin  appears  a  uniform  bright 
red.  As  a  rule,  the  eruption  is  widespread  when  the 
child  is  first  examined.  The  color  increases  in  intensity 
for  two  or  three  days,  begins  to  fade  in  three  or  four  days 
after  the  onset,  and  lasts  in  all  about  a  week.  At  about 
the  end  of  the  first  or  second  week  the  skin  begins  to  peel 
in  large  or  small  shreds,  and  this  characteristic  desquama- 
tion continues  several  weeks.  During  the  height  of  the 
disease  fever  persists,  the  throat  is  sore,  swollen,  bright 
red,  and  often  seriously  inflamed,  and  the  tonsils  may  be 
covered  with  white  patches  resembling  diphtheritic  mem- 
brane. The  tongue  loses  its  coating  and  becomes  bright 
red  with  the  minute  natural  prominences  unusually  large 
("strawberry  tongue").     The  rapidity  of  the  pulse   is 


THE  SICK  BABY.  32  I 

greater  than  the  elevation  oi  the  temperatnre  wonkl  lead 
one  to  expect.  The  fever  disappears  in  seven  to  nine  days, 
and  the  acute  stage  is  over.  In  bad  cases  with  severe 
throat-symptoms  fever  may  last  much  longer  than  this, 
while  in  the  mildest  cases  the  rash  may  disappear  in 
twenty-four  hours  and  there  may  have  been  but  the  slight- 
est fever.  The  disease  is  always  alarming,  because  the 
cases  which  begin  mildly  may  eventually  become  severe, 
or  be  followed  by  inflammation  of  the  ears,  pneumonia, 
abscesses  of  the  glands  in  the  neck,  or  Bright' s  disease. 
The  last-mentioned  disease  may  come  on  even  after  the 
child  has  been  convalescent  from  the  fever  for  two  or 
three  weeks.  It  must  be  guarded  against  with  especial 
care. 

In  the  way  of  treatment,  the  slightest  possible  chance 
of  taking  cold  must  be  avoided.  The  child  should  be  con- 
fined to  bed,  and  the  windows  must  not  be  opened  in 
the  slightest,  or  any  bathing  or  sponging  employed,  until 
the  physician  in  charge  is  asked  what  he  wishes  done 
in  the  matter.  Very  often  he  will  have  the  child 
oiled  all  over  as  an  additional  safeguard  against  cold 
and  to  keep  the  desquamating  skin  from  getting  about 
the  room.  Further  preventive  measures  against  spread- 
ing consist  in  isolating  the  child  the  moment  the  mother 
suspects  that  it  may  have  scarlet  fever,  in  carrying 
out  careful  disinfection  during  the  attack,  and  in  de- 
ferring the  removal  of  quarantine  until  she  is  quite  sure 
that  the  danger  is  over.  The  caution  about  bathing  is 
given  not  because  it  expresses  the  writer's  views  on  its 
danger,  but  because  some  physicians  are  greatly  opposed 
to  all  bathing  in  this  disease.  It  does  not  apply  to  the 
first  hot  bath,  useful  at  the  beginning  of  nearly  any  acute 
disease  in  children. 

21 


322  THE    CARE    OF   THE   BABY. 

Measles;  Rubeola;  Morbilli. — Probably  the  most  fre- 
quent and  most  contagions  of  the  eruptive  fevers;  occur- 
ring oftenest  in  the  cold  season,  and  rarely  in  babies 
less  than  one  year,  or,  especially,  six  months,  old.  It 
appears  to  be  contagious  even  during  the  period  of  in- 
cubation. It  is  caught  generally  by  close  contact  with 
infected  children,  for,  although  the  infection  can  cling 
to  objects  about  the  patient  and  be  carried  by  a  third 
person,  this  occurrence  is  certainly  rare.  The  germ  has 
little  vitality  as  compared  with  that  of  scarlet  fever. 
Second  attacks  of  measles,  although  more  frequent  than 
is  the  case  with  scarlet  fever,  are  still  very  unusual.  In 
the  great  majority  of  the  reported  instances  so  often  heard 
of  the  children  in  reality  had  measles  upon  one  occa- 
sion and  German  measles  or  some  affection  of  the  skin 
upon  the  other.  Measles  is  usually  regarded  as  a  dis- 
ease of  little  consequence;  but  this  is  an  error.  In  children 
not  previously  in  good  health  it  may  prove  fatal,  gener- 
ally by  inducing  pneumonia,  tuberculosis,  or  some  other 
complication.  The  attack  begins  with  all  the  symptoms 
of  a  very  bad  cold,  such  as  feverishness,  sneezing,  run- 
ning of  the  nose  and  eyes,  heavy,  stupid  expression  of  the 
face,  hoarseness,  and  cough.  The  child  is  so  often  stupid 
and  sleepy  that  the  expression  "sleeping  for  the  measles " 
has  become  a  common  one.  Frequently  the  onset  is 
much  milder,  and  the  child  is  out  of  doors,  very  slightly 
sick.  The  rash  begins  upon  the  fourth  day  of  the  dis- 
ease, in  the  form  of  purplish-red,  slightly  elevated,  flat- 
tened papules  about  the  size  of  a  split  pea.  These  ap- 
pear first  upon  the  face,  but  spread  over  the  entire  body 
in  about  twenty-four  hours.  Many  of  them  remain  dis- 
tinct, while  others  unite  by  their  edges  and  form  irregu- 
lar blotches  and  lines  many  of  which  are  crescent-shaped. 
This  grouping  is  very  characteristic  of  the  disease.    Plate 


Pl.ATK    III. 


Girl  with  measles,  showing  the  characteristic  grouping  of  the  eruption  and  the  peculiar 
heavy  and  swollen  appearance  of  the  face.     (From  a  photograph.) 


THE  SICK  BABY.  323 

III.  is  from  a  pliotograpli  of  a  child  with  measles,  and 
shows  very  well  both  the  nature  of  the  eruption  and  the 
heavy,  somewhat  swollen  face  and  thickened  lips.  All 
the  symptoms  mentioned  persist  or  grow  worse,  and 
there  may  also  be  diarrhoea.  By  the  sixth  or  seventh 
day  of  the  disease  the  fever  has  ceased,  and  by  the 
seventh  or  eighth  day  the  rash  has  disappeared.  There 
is  often  a  faint  mottling  and  a  fine  desquamation  of 
branny  scales  lasting  a  week  after  the  rash  has  gone. 
There  is  no  peeling  as  in  scarlatina.  At  the  beginning 
of  the  attack  a  hot  bath  may  be  given,  but  other  treat- 
ment will  be  directed  by  the  physician.  It  is  best  to  keep 
the  child  in  bed  about  ten  days,  to  avoid  the  danger 
of  taking  cold.  Bright  light  should  be  excluded,  since 
the  eyes  are  inflamed. 

German  Measles;  Rubella;  Rbtheln. — The  term 
"French  measles"  is  only  an  incorrect  name  for  this 
disease.  "Roseola"  is  another  term  very  loosely  used, 
and  applied  to  other  affections  as  well.  German  measles 
is  just  as  distinct  from  ordinary  measles  as  scarlet  fever 
is.  That  a  child  has  suffered  from  one  of  the  three  dis- 
eases protects  it  in  no  way  from  the  other  two.  It  is  less 
common  than  these,  oftenest  seen  in  the  winter-time,  very 
contagious,  rarely  occurs  twice  in  one  person,  and  seldom 
attacks  children  under  one  year  old.  The  contagion  is 
transmitted  as  in  measles.  The  disease  is  quite  variable, 
in  some  cases  resembling  measles,  and  in  others  scarlet 
fever,  so  closely  that  even  the  attending  physician  cannot 
make  a  positive  diagnosis.  There  are  seldom  any  pro- 
dromal symptoms,  or  they  are  only  those  of  a  very  slight 
cold,  and  are  followed  by  the  rash  within  twenty-four 
hours.  This  comes  out  first  on  the  face  as  pale-rose,  very 
slightly  elevated  spots,  of  the  size  of  a  pin-head  up  to  that 


324  THE    CARE    OE  THE   BABY. 

of  a  split  pea,  which  do  not  run  together  into  distinct 
small  blotches  as  in  measles,  althoug-h  they  do  very  often 
fuse  into  large  areas  of  an  almost  uniform  redness  looking 
much  like  the  rash  of  scarlet  fever.  The  eruption  spreads 
rapidly  downward  over  the  body,  like  a  wave  in  that  it 
fades  rapidly  also,  and  may  have  nearly  disappeared  from 
the  face  by  the  time  it  is  fully  out  on  the  feet.  It  is  gone 
from  every  part  by  the  third  or  fourth  daj'.  The  s}-mp- 
toms  during  the  presence  of  the  rash  are  very  moderate 
fever  with  slight  running  of  the  eyes  and  nose  and  slight 
sore  throat.  Desquamation  of  a  few  branny  scales  often 
follows  the  rash.  Care  must  be  taken  to  guard  against 
cold,  as  bronchitis  or  pneumonia  may  develop. 

Chicken-pox;  Varicella. — A  very  common  and  con- 
tagious disease,  rarely  occurring  twice  in  one  person,  and 
not  so  often  attacking  those  under  six  months  of  age — 
although  this  last  is  less  true  of  it  than  of  measles  and  scar- 
let fever.  It  resembles  the  mildest  varioloid  very  closely, 
but  is  an  entirely  distinct  disease.  Contagion  is  trans- 
mitted by  the  breath  or  scabs,  and  probably  exceptionally 
it  is  possible  for  a  third  person  to  carry  it  from  the  sick  to 
the  well.  The  disease  is  generally  very  mild.  Prodro- 
mal symptoms  are  absent.  The  discovery  of  the  charac- 
teristic rash  is  usually  the  first  symptom,  although  some- 
times there  is  slight  fever  and  malaise  for  a  few  hours 
before.  The  eruption  consists  at  first  of  rose-colored 
spots  which  usually  appear  first  on  the  neck  and  trunk, 
and  which  change  in  a  few  liours  into  prominent  vesicles, 
from  a  few  to  hundreds  in  number,  one-quarter  of  an 
inch  or  less  in  diameter,  filled  with  a  clear  watery  fluid, 
and  sometimes  surrounded  by  a  slight  red  halo.  The 
vesicles  come  out  in  crops,  the  older  ones  rapidly  dr>'ing 
up  and  forming  scabs.     There  may  be  mild  fever  during 


THE   SICK  BABY.  325 

the  i^resence  of  the  eruption.  The  attack  lasts  a  week 
or  less,  although  all  the  scabs  may  not  be  gone  for  some 
time  longer.  Plate  IV.,  from  a  photograph,  shows  the 
vesicles  dotted  over  the  trunk  in  a  moderately  well-de- 
veloped case  of  chicken-pox. 

The  child  should  be  confined  to  the  house,  away  from 
other  children,  or  to  bed  if  there  is  an  extensive  eruption. 
Other  treatment  is  not  often  required.  Care  should  be 
taken  that  the  spots  are  not  picked  at  or  torn,  as  this 
increases  the  danger  of  leaving  scars.  If  any  vesicles  have 
become  very  large  and  much  pus  seems  to  be  forming 
under  the  scabs,  they  should  be  treated  antiseptically  by 
the  family  physician,  in  order  to  limit  their  size  and  to 
prevent  scarring  as  far  as  possible. 

Smal!-pox;  Varioloid. — Varioloid,  or  modified  small- 
pox^ is  in  reality  a  mild  form  of  small-pox,  modified  by 
occurring  in  one  who  has  been  partially  protected  by 
vaccination.  Small-pox  in  any  form  is,  fortunately,  rare 
if  vaccination  is  enforced.  The  differences  between  the 
symptoms  of  the  modified  and  grave  forms  are  those  of 
degree  only.  Either  form  may  be  caught  from  a  person 
suffering  with  the  other.  The  disease  is  very  contagious, 
and  the  contagious  principle,  which  arises  chiefly  from 
the  skin  and  from  the  lungs,  permeates  the  air  about 
the  patient,  and  has,  besides,  a  remarkable  tenacity  of 
life,  since  it  may  remain  active  for  months  in  the  cloth- 
ing or  in  the  scabs  which  have  fallen.  As  a  rule,  one 
attack  protects  against  a  second,  but  instances  of  two  or 
more  attacks  are  quite  numerous.  The  disease  occurs 
oftenest  in  the  cold  season.  In  the  unvaccinated  it  spares 
no  period  of  life.  It  may  even  sometimes  attack  children 
before  birth.  The  symptoms  of  the  invasion  consist,  if 
well  marked,  of  more  or  less  headache,  pain  in  the  back. 


326  THE    CARE    OE    THE   BABY. 

high  fever,  drowsiness,  vomiting,  and  sometimes  convnl- 
sions.  A  red  flush  over  the  skin  may  be  present.  Some- 
times, however,  the  initial  symptoms  are  so  mild  that 
they  are  unnoticed.  The  eruption  appears  on  the  third 
day  of  the  disease,  or  sometimes,  in  varioloid,  on  the 
first  or  second  day.  It  first  consists  of  .spots  which 
feel  like  shot  under  the  skin,  appear  on  any  part  of  the 
body,  grow  more  prominent  by  the  time  they  are  a  day 
old,  and  on  the  next  da)- — the  fifth  of  the  disease — be- 
come projecting,  red,  conical  papules  with  a  little  clear, 
watery  fluid  at  the  apex.  Very  quickly  the  whole  papule 
now  becomes  filled  with  clear  fluid  (vesicle).  This  is 
very  unlike  chicken-pox,  in  which  there  is  never  any 
shot-like  sensation  and  in  which  the  spots  are  full  of  fluid 
almost  from  the  beginning.  The  vesicles  of  typical 
small-pox  now  go  on  to  produce  pus  (pustules),  but  in 
varioloid  many  of  the  papules  never  form  vesicles,  while 
most  of  the  vesicles  which  do  form  begin  to  dry  up  and 
produce  crusts  by  the  eighth  or  ninth  day  of  the  disease, 
without  going  through  the  pustular  stage.  Some  of  the 
vesicles,  however,  do  pustulate,  and  are  not  only  longer 
in  producing  the  scabs,  but  also  leave  marks  afterward. 
The  scabs  begin  to  fall  by  about  the  fourteenth  day.  The 
fever  and  the  other  initial  symptoms  usually  disappear 
when  the  rash  comes  out,  but  return  in  typical  small-pox 
when  the  eruption  becomes  pustular.  Contagion  certainly 
lasts  until  every  trace  of  scabbing  has  disappeared  and 
thorough  disinfection  has  been  made,  but  the  contagious 
power  is  so  strong  that  it  is  best  to  quarantine  the  pa- 
tient for  eight  weeks.  Isolation  and  disinfection  should 
be  prompt  and  perfect,  and  everybody  in  the  house 
should  be  re-vaccinated  at  once.  The  treatment  must 
be  left  entirely  to  a  physician. 


THE   SICK  BABY.  327 

Vaccinia;  Cow-pox;  Vaccination. — Vaccinia  prob- 
ably is  small-pox  occurring  in  cattle,  but  so  modified  by 
this  fact  that  when  introduced  by  "vaccination"  into 
the  human  body  it  produces  only  a  single  sore,  although 
it  protects  the  whole  system  from  a  general  attack.  The 
fact  that  small-pox  made  such  frightful  ravages  before 
vaccination  was  known,  yet  is  comparatively  uncom- 
mon now  if  vaccination  is  diligently  practised,  is  positive 
proof  of  the  value  and  the  great  importance  of  the  pro- 
cedure for  every  child.  The  supposed  dangers  of  trans- 
mitting other  diseases  by  vaccinating  with  human  lymph 
are  largely  imaginary,  and  with  the  calf  (bovine)  lymph 
they  no  longer  exist.  The  danger  of  erysipelas,  lock- 
jaw, or  blood-poisoning  setting  in  is  no  greater  from  this 
sore  than  from  a  scratch  or  sore  of  any  other  nature.  The 
best  time  to  vaccinate  is  at  about  the  age  of  two  or  three 
months,  provided  the  child  has  no  eruption  of  the  skin 
and  is  in  good  health  in  other  respects.  Girl  babies 
should  certainly  not  have  it  done  on  any  part  of  the  arm 
where  the  scar  will  show  in  later  years.  The  thigh  or 
the  leg  is  a  very  desirable  place. 

After  vaccination  nothing  is  seen  until  the  second  or 
third  day,  when  a  red  papule  appears,  which  grows 
larger,  and  which  by  the  fifth  or  sixth  day  after  vaccina- 
tion has  become  a  vesicle  filled  with  a  watery  fluid.  This 
increases  in  size  until  the  eighth  day,  when  it  is  nearly 
as  large  as  a  ten-cent  piece.  By  the  tenth  day  the 
vesicle  has  become  a  pustule,  with  its  contents  yellowish 
and  cloudy,  and  with  a  broad  red  ring  two  to  three  inches 
in  diameter  surrounding  it.  By  the  eleventh  or  twelfth 
day  the  redness  lessens  and  the  fluid  begins  to  dry;  by 
the  fourteenth  day  the  scab  is  pretty  well  formed;  and  by 
the  end  of  three  weeks  or  thereabouts  this  falls  off" — if, 
indeed,  the  child  has  not  rubbed  it  off  before — and  leaves 


328  TJIE    CARE    OF  THE   BABY. 

a  scar  which  finally  becomes  white  and  pitted.  Generally 
there  is  slight  fever  by  the  fourth  or  fifth  day  after  vacci- 
nation. This  increases,  and  is  at  its  height  by  the  ninth 
or  tenth  day.  At  this  time  there  may  be  restlessness  and 
irritability,  with  considerable  swelling  and  pain  of  the 
arm  or  leg.  Sometimes  a  child  seems  quite  ill.  After 
the  vesicle  begins  to  form  it  should  be  guarded  against 
injury  by  covering  it  with  a  vaccination  shield,  or  by  a 
pad  of  salicylated  absorbent  cotton  held  in  place  with 
adhesive  plaster  or  a  roller  bandage.  Often  the  physician 
prefers  to  apply  the  cotton  or  the  shield  immediately  after 
vaccination,  in  order  to  guard  against  any  possible  danger 
of  blood-poisoning.  If  the  vaccination  does  not  "  take," 
it  must  be  repeated  until  it  does.  It  is  only  very  rarely 
that  the  effort  will  not  at  last  succeed. 

Most  children  who  have  been  successfully  vaccinated 
will  never  develop  small-pox,  but  in  others  the  protection 
ceases  to  a  certain  degree  after  a  number  of  years,  and 
they  may  contract  varioloid.  Absolute  protection  may 
be  counted  as  lasting  about  five  or  six  years.  A  child 
should  therefore  be  re-vaccinated  at  the  age  of  six  years, 
and  again  at  that  of  twelve  years.  When  small-pox  is 
prevalent  every  one  in  the  house  should  be  vaccinated 
who  has  not  had  it  done  successfully  within  a  few  years. 

Erysipelas. — This  disease  may  attack  any  age,  is  com- 
monest in  early  spring,  and  is  contagious  to  a  limited 
extent  only.  It  develops  usually  about  a  wound,  even 
though  it  be  a  very  small  one;  consequently  in  early 
infancy  it  is  generally  seen  about  the  navel.  When  not 
about  a  wound,  it  occurs  oftenest  on  the  face.  The  con- 
tagious principle  probably  emanates  from  the  .skin,  and 
may  adhere  to  furniture  or  to  clothing,  and  be  carried  by 
another  person  from  the  sick  to  the  well.     One  attack 


THE   SICK'  BABY.  329 

does  not  protect  in  the  slightest  from  others.  The  dis- 
ease begins  with  fever,  languor  or  restlessness,  delirium 
or  stupor,  and  pain  in  the  part  involved.  These  symp- 
toms are  often  preceded  by  a  convulsion  or,  in  older 
children,  a  chill.  The  eruption  appears  in  a  few  hours. 
The  skin  of  some  part  of  the  body  becomes  shiny  and  as 
evenly  bright  red  as  though  red  ink  had  been  spilled  on 
it.  The  color  disappears  upon  pressure,  but  returns 
rapidly.  Sometimes  small  blisters  form.  The  tissues 
beneath  the  surface  become  much  swollen.  The  inflam- 
mation, pain,  and  fever  continue  for  two  or  three  days, 
and  after  four  or  five  days  the  attack  is  over,  at  least  in 
the  original  area.  Unfortunately,  the  eruption  tends  to 
spread  in  different  directions,  and  the  disease  may  thus 
last  indefinitely.  Desquamation  in  sm^U  or  large  scales 
occurs. 

Erysipelas  is  usually  very  fatal  in  children  one  or  two 
weeks  old,  and  severe  at  all  times  in  infancy.  A  child 
sick  with  it  should  be  separated,  especially  from  any  one 
who  has  even  a  slight  abrasion  of  the  skin.  A  new-born 
baby  with  the  disease  must  be  at  once  removed  from  its 
mother  for  the  sake  of  the  latter,  for  erysipelas  in  a  woman 
after  confinement  is  very  dangerous.  Quarantine  should 
certainly  last  as  long  as  there  is  any  scaling.  Probably 
two  weeks  from  the  onset  of  the  disease  would  be  an 
average  figure  for  cases  in  which  the  eruption  had  not 
spread  from  the  original  spot. 

Diphtheria. — A  very  common,  contagious,  and  danger- 
ous disease,  attacking  any  age,  although  rare  in  early 
infancy,  and  somewhat  more  frequent  in  damp  and  cold 
weather.  The  contagious  principle  is  contained  espe- 
cially in  the  secretion  from  the  nose  and  throat.  It  mav 
stick  to  clothing  or  other  objects,   retain   its  poisonous 


330  THE   CARE    OF   THE   BABY. 

properties  for  months,  and  be  carried  from  the  sick  to  the 
well.  The  inhalation  of  sewer-gas  has  often  been  sup- 
posed to  cause  the  disease.  This  can  be  true  only  in  so 
far  as  the  breathing  of  the  gas,  like  the  living  under  any- 
other  unhygienic  condition,  may  debilitate  the  system 
and  irritate  the  throat,  thus  rendering  the  child  more 
susceptible  to  the  action  of  the  diphtheritic  germs.  One 
attack  in  no  way  protects  from  subsequent  ones.  The 
disease  begins  with  feverishness,  loss  of  appetite,  debility, 
heaviness,  and  sore  throat.  Examination  of  the  throat 
at  this  stage  may  show  the  tonsils  swollen  and,  perhaps, 
exhibiting  a  few  dotted  white  points  as  in  ordinary  ton- 
sillitis,but  nothing  characteristic.  In  a  few  hours  or  by 
the  next  day  there  has  developed,  except  in  the  mildest 
cases,  a  white  opaque  membrane  covering  one  or  both 
tonsils  and  extending  to  other  parts  of  the  throat.  The 
child  continues  feeble  and  feverish  ;  the  membrane 
spreads;  the  glands  below  the  jaw  on  each  side  are  gen- 
erally swollen;  and  there  is  apt  to  be  a  running  from  the 
nose,  due  to  the  extension  of  the  disease  to  it. 

In  very  many  cases  the  membrane  develops  first  in  the 
nose,  and  may  not  spread  beyond  it.  These  cases  are 
easily  overlooked  and  are  a  source  of  great  danger  to 
other  children. 

In  average  cases  which  recover  the  patches  begin 
to  disappear  after  a  week,  and  are  entirely  gone 
after  ten  to  fourteen  days.  The  symptoms  mean- 
while have  slowly  ceased,  except  the  very  decided  and 
characteristic  weakness,  which  persists  for  a  long  time. 
In  unfavorable  cases  the  membrane  continues  to  form  and 
the  child  finally  dies  of  exhaustion. 

The  membrane  very  often  spreads  to  the  lar\  nx  and  pro- 
duces larynigcal  diphthei'ia — that  is,  membranous  a-onp. 
This  very  dangerous  condition  is  apt  to  come  on  between 


THE   SICK  BABY.  33  I 

the  tliird  and  sixth  da\s  of  the  disease.  Sometimes, 
however,  the  membrane  attacks  the  larynx  first  or  solely. 
Nearly  every  case  of  membranous  croup  is  in  reality  laryn- 
geal diphtheria.  Although  there  are  occasional  instances 
in  which  the  membrane  in  the  larynx  is  not  diphthe- 
ritic, the  diagnosis  of  such  an  occurrence  cannot  ordina- 
rily be  made  with  certainty.  The  first  symptom  of  mem- 
branous croup  is  hoarseness,  which  is  soon  followed  by 
rapid  and  noisy  breathing  and  the  peculiar  croupy  cough. 
Unlike  spasmodic  croup,  the  obstruction  to  breathing  is 
persistent.  The  child  sits  up  in  bed  laboring  for  breath, 
looks  pale  and  bluish,  and  will  die  painfully  of  suffoca- 
tion in  a  few  hours  or  days  if  relief  cannot  be  had. 

The  danger  of  paralysis  following  diphtheria  has 
already  been  alluded  to  (p.  290).  It  is  most  apt  to  come 
on  during  convalescence,  between  the  third  and  fifth 
weeks. 

With  regard  to  the  treatment  of  diphtheria,  any  child 
who  shows  even  a  small  whitish  spot  in  the  throat 
should  be  isolated  promptly  and  be  visited  by  the  family 
physician.  It  may  be  nothing  of  consequence,  but  it 
may  be  the  beginning  of  diphtheria,  and  isolation  may 
keep  the  disease  from  spreading  to  others.  Should  the 
physician  order  applications  to  the  throat,  his  instruc- 
tions must  be  carried  out  implicitly,  no  matter  how  cruel 
they  seem.  Whoever  paints  the  throat  must  take  par- 
ticular care  that  none  of  the  membrane  is  coughed  into  his 
or  her  nose,  e}es,  or  mouth.  The  remarkable  reduction 
of  strength  which  attends  and  follows  the  disease  must 
never  be  forgotten.  Death  from  sudden  heart  failure 
has  not  unfrequently  occurred  after  all  symptoms  had 
disappeared.  Consequently,  no  child  suffering  from  or 
convalescent  from  diphtheria  should  be  allowed  to  get 
out  of  bed,  or  even  to  sit  up  of  itself,  until  the  physi- 


332  THE    CARE    OF   THE   BABY. 

cian  in  charge  permits  ;  and  if  it  must  be  taken  np,  it 
should  be  lifted  very  slowly  and  carefully.  All  the  pre- 
cautions for  isolation  and  disinfection  must  be  followed 
exactly.  All  cloths  used  for  the  reception  of  membrane 
or  of  saliva  should  be  burned  at  once.  If  there  is  any 
difficulty  in  breathing  caused  by  diphtheria  of  the  larynx, 
the  air  of  the  room  may  be  moistened,  as  well  as  disin- 
fected, by  a  disinfectant  vapor  (Appendix,  103).  Quar- 
antine should  continue  until  examination  of  the  secretion 
of  the  nose  and  throat  by  a  bacteriologist  shows  that  the 
germs  of  the  disease  are  no  longer  present.  When  it  is 
not  possible  to  have  this  examination  made,  quarantine 
should  continue  for  two  weeks,  or,  in  bad  cases,  three 
weeks,  after  all  trace  of  membrane  has  disappeared.  In 
cases  of  laryngeal  diphtheria  parents  should  not  hesitate 
to  give  permission  for  any  operation  which  the  physician 
in  charge  may  advise.  Prompt  consent  may  mean  the 
saving  of  life,  and  certainly  generally  gives  temporary 
relief  at  the  least. 

Whooping-cough  ;  Pertussis. — A  very  prevalent  con- 
tagious disease  of  children;  oftenest  seen  under  the  age 
of  five  years,  and  very  common  in  the  first  year.  It  is 
frequent  at  all  seasons  of  the  year.  It  is  more  serious 
than  is  ordinarily  supposed,  and  an  appalling  number  of 
children  die  from  its  effects,  usually  as  the  result  of  some 
complication,  especially  pneumonia,  tuberculosis,  con- 
vulsions, or  affections  of  the  bowels.  The  contagious 
principle  seems  to  reside  in  the  expectoration  and  the 
breath,  and  probably  is  active  during  the  whole  attack. 
It  usually  requires  close  proximity  to  communicate  it.  The 
carrying  of  the  contagion  by  a  third  person  is  certainly 
very  unusual.  A  second  attack  occurs  with  even  greater 
rarity  than  is  the  case  in  measles  and  scarlatina.     The 


THE   SICK  BABY.  333 

disease  may  be  severe,  or  so  light  that  the  child  is 
hardly  incommoded  by  it.  The  younger  the  child  the 
more  dangerous  is  the  disease  likely  to  be.  The  attack 
begins  with  slight  cold  in  the  head  and  a  troublesome 
cough  which  is  worse  at  night  and  not  relieved  by  the 
ordinary  treatment  for  bronchitis.  In  a  very  few  da3's 
the  cough  occurs  in  longer  paroxysms,  during  which  the 
child  becomes  red  in  the  face  and  seems  hardly  able  to 
get  its  breath,  and  after  which  it  may  vomit.  After  this 
stage  of  invasion^  which  averages  two  weeks,  but 
which  is  very  variable  and  may  last  for  only  a  few 
days,  the  whooping  or  paroxysjiial  stage  begins.  The 
paroxysms,  or  ' '  kinks, ' '  as  they  are  often  called,  are 
now  longer  and  more  intense.  The  child  gives  a  long 
series  of  rapidly-repeated  short  coughs  without  draw- 
ing breath,  and  continues  this  until  it  is  nearly 
blue.  At  last  it  makes  a  long-drawn  inspiration  with 
a  peculiar  loud  crowing  sound — the  well-known  whoop. 
Very  often  the  whole  process  is  repeated  immediately,  and 
perhaps  again  and  again.  The  paroxysms  are  frequently 
so  severe  that  they  are  followed  by  vomiting,  and  the 
child  may  lose  flesh  and  strength  from  its  inability  to 
retain  food.  A  large  amount  of  stringy  mucus  flows 
from  the  mouth  after  the  attacks,  and  may  be  accom- 
panied by  blood.  The  paroxysms  are  most  frequent  at 
night.  In  a  mild  case  there  are  only  five  or  six  in 
twenty-four  hours,  but  in  a  severe  one  there  are  forty  or 
fifty  or  more.  In  the  mildest  cases  it  sometimes  happens 
that  no  whooping  occurs  at  any  time;  still,  the  peculiar 
paroxysmal  character  of  the  cough  often  makes  the 
nature   of    the   disease   plain. 

The  intensity  of  the  attack  remains  the  same  for  from 
three  to  six  weeks  in  cases  of  average  severity,  and  then 
the  stage  of  decline  begins.     Its  duration  is  very  indefi- 


334  ^-^^    CARE    OF  THE   BABY. 

iiite.  The  paroxysms  become  less  frequent  and  the  cough 
much  looser,  andlittle  by  little  the  whooping  disappears, 
until  it  ceases  by  six  or  eight  or  more  weeks  from  the 
first  onset  of  cough,  and  only  a  bronchitis  is  left,  which 
lasts  an  indefinite  time.  When  the  attack  occurs  in  the 
autumn  the  bronchitis  is  very  obstinate,  and  may  continue 
with  occasional  whooping  throughout  the  winter. 

Just  how  long  the  disease  is  contagious  is  uncertain. 
We  are  safe  in  saying  that  it  averages  at  least  six  or  eight 
weeks  from  the  beginning  of  the  attack.  It  probably 
grows  less  contagious  as  time  passes.  If  the  whoop  has 
once  distinctly  stopped  and  there  has  been  a  period  of 
some  days  without  it,  we  may  call  the  disease  over,  even 
although  the  whooping  should  begin  again  later.  The 
second  whooping  is  a  sort  of  habit  left  by  the  disease,  and 
children  have  been  known  to  have  it  even  a  year  after  the 
attack  was  over.  It  cannot  properly  be  considered  a  part 
of  the  infectious  disease. 

Treatment  should  be  ordered  by  a  physician  in  every 
case,  not  only  on  account  of  the  discomfort  which 
attends  the  attack,  but  also  because  of  the  danger  of 
complications.  Although  the  disease  can  only  occasion- 
ally be  cut  short,  it  can  usually  be  relieved  very  de- 
cidedly. If  one  plan  of  treatment  does  not  answer, 
another  probably  will.  The  child  should  have  an  abun- 
dance of  fresh  air,  be  warmly  clad,  and  not  be  exposed 
to  draughts.  Sleeping  in  a  room  which  has  been  well 
aired  and  not  occupied  all  day  will  often  prevent  many 
paroxysms  at  night.  During  the  paroxysm  the  child's 
head  should  be  supported  by  the  hand.  In  very  bad 
cases,  in  which  the  child  becomes  almost  or  quite  uncon- 
scious and  ceases  to  breathe,  it  should  be  slapped  in  the 
face  with  a  cold  wet  towel.  Fortunately,  these  cases  are 
not  very  common.  Later  in  the  disease  a  change  of  air 
will  sometimes  do  wonders. 


THE   SICK  BABY.  335 

Mumps. — A  painful  but  not  dangerous  inflammation  of 

the  salivary  glands,  which  are  situated  in  front  of,  below, 
and  behind  the  ears  and  below  the  jaw.  It  is  commonest 
in  the  cold  season,  and  seldom  attacks  very  young  infants. 
It  is  distinctly  contagious,  even  during  incubation. 
Close  contact  is  usually  required  to  contract  it,  although 
instances  of  its  having  been  carried  are  known.  One 
attack  iisually  protects  from  subsequent  ones.  The  dis- 
ease begins  with  dulness,  more  or  less  fever,  and  pain 
and  stiffness  about  the  jaws,  usually  on  one  side.  A 
swelling,  situated  below  and  slightly  behind  the  ear, 
rapidly  develops,  and  becomes  very  marked  within  forty- 
eight  hours.  There  is  much  tenderness  on  pressure, 
chewing  is  sometimes  impossible,  talking  and  swallowing 
are  difficult,  and  in  some  cases  the  mouth  can  scarcely 
be  opened.  After  a  day  or  two  the  other  side  of  the  face 
generally  becomes  affected  in  the  same  way.  The  whole 
attack  lasts  about  a  week.  Treatment  consists  in  rest  in 
bed  and  the  administration  of  a  laxative  and  a  fever  mixt- 
ure (Appendix,  108).  Food  should  be  soft.  A  wad  of 
cotton  covered  on  the  outside  with  oil  silk  may  be  fast- 
ened over  the  inflamed  region.  Hot  fomentations  or 
poultices  may  be  applied  if  the  pain  is  very  great.  Quite 
rarely  the  disease  becomes  dangerous  from  complications. 
The  duration  of  contagiousness  is  uncertain,  but  isolation 
should  last  ten  days  or  two  weeks  after  the  symptoms 
have  disappeared. 

Influenza;  Grippe. — An  infectious  disease,  contagious, 
prevailing  in  widespread  epidemics,  especially  in  winter 
and  spring,  and  attacking  all  ages.  One  attack  in  no 
way  protects  from  a  later  one.  Little  is  known  about  the 
duration  of  incubation  or  the  length  of  time  during  which 
the  patient  is  capable  of  infecting  others.     The  infection 


336  THE    CARE    OE  THE   BABY. 

is  probably  contained  in  the  secretion  of  the  respiratory 
apparatns.  It  is  a  mistake  to  characterize  every  severe 
cold  with  some  fever  as  "grippe."  The  symptoms  of  the 
disease  begin  suddenly  and  are  characteristic,  although 
they  varv  greatly.  Cases  may  be  mild  or  very  severe. 
We  may  find  the  respiratory  symptoms  most  marked,  as 
coryza  and  cough.  Other  cases  show  digestive  disturb- 
ances especially,  as  vomiting  and  diarrhoea.  In  still 
others  nervous  symptoms  of  some  sort  are  the  most  prom- 
inent, such  as  intense  aching  in  the  head  and  bod}-,  or 
delirium,  or  dulness,  or  other  suggestions  of  meningitis. 
But  whether  or  not  any  of  the  symptoms  mentioned  be 
present — and  they  are  often  absent,  especially  in  infants 
and  young  children — there  are  the  characteristic  presence 
of  a  degree  of  prostration  out  of  all  proportion  to  the 
apparent  cause  for  it,  and  a  continuance  of  fever,  not 
usually  high,  to  account  for  which  there  is  nothing  dis- 
coverable. This  prostration  is  apt  to  be  especially  great 
in  infants. 

Mild  cases  of  grippe  last  three  or  four  days.  Severe 
ones  may  also  be  short,  or  may  be  prolonged  for  a  couple 
of  weeks.  Complications  are  very  frequent,  those  in 
children  being  especially  pneumonia,  bronchitis,  tuber- 
culosis, inflammation  of  the  glands  of  the  neck,  inflam- 
mation of  the  ears,  and  severe  diarrhoea.  After  every 
case  of  grippe  there  is  liable  to  be  unusually  prolonged 
debility.  Relapses,  too,  easily  take  place.  For  all  these 
reasons  a  mother  should  not  undertake  the  treatment  of 
a  case  among  her  children  except  in  the  line  of  putting 
the  patient  to  bed  and  preventing  the  spread  of  the  dis- 
ease. It  is  often  impos.sible  to  do  the  latter,  but  the 
attempt  should  be  made,  especially  when  there  are  infants 
in  the  household.  The  isolation  should  continue  until 
the  attack  is  thoroughly  over. 


THE   SICK  BABY. 


337 


(6)   MISCELLANEOUS   DISORDERS   AND   HABITS. 

Premature  Infants. — A  child  may  be  born  in  the  sev- 
enth or  eighth  month  of  pregnancy,  or  even  earlier,  long 
before  it  is  quite  ready  to  live  outside  of  the  mother's 
body,  and  when  it  weighs  not  more,  perhaps,  than  two 
and  a  half  or  three  pounds.  We  need  not  necessarily 
despair  of  the  life  of  a  baby,  however  unpromising  it 
seems  at  first.  Children  born  at  six  and  a  half  calendar 
months  have  in  very  rare  instances  lived.  But  even  at 
the  age  of  seven   months  the  vitality  of  the  premature 


^iHiKlM 


fly  y  i,:U.r,h|i,|,, 


caininiiiiiiiiiiwiiniiiuiiiiiiiiiiiiiiiiiiiimiiiiiiMn 


Fig.  77. — Incubator. 

infant  is  low,  and  great  care  is  required  to  maintain  life. 
The  great  needs  are  nourishment  and  heat.  The  maternity 
hospitals  employ  an  apparatus,  called  a  coiivcuse^  brooder^ 
or  incubator^  especially  devised  to  supply  the  latter  (Fig. 
']^^.  For  family  use  a  couveuse  may  be  bought  at  the 
instrument-makers,  or  hired  from  some  of  them.  This 
is  perhaps  better,  as  the  apparatus  is  costly.  But  with 
an  increased  degree  of  attention  it  may  be  entirely  done 
without  fairly  well.     If  a  premature  baby  is  bathed  at 


338 


THE   CARE    OE   THE  BARY. 


all  immediately  after  birth,  the  temperature  of  the  water 
should  be  102°  F. ,  aud  the  greatest  care  should  be  taken 
while  dr)"ing  to  see  that  the  child  is  not  chilled.  It 
should  be  made  very  warm  by  swaddling  it  in  raw  cotton, 
head  and  all,  leaving  only  the  face  exposed,  wrapping  it 
about  with  a  blanket,  and  t}-ing  it  around  with  a  roller 
bandage.  Hot  bottles  should  be  placed  on  each  side  of 
it  as  it  lies  thus  wrapped  up  in  the  bed,  and  fresh  ones 
be  substituted  frequently.  A  very  convenient  method  is 
to  place  the  child  in  a  baby's  bath-tub  half  full  of  raw 
cotton  in  which  numerous  hot  bottles  have  been  con- 
cealed, not  near  enough  to  the  child  to  run  any  risk  of 
burning  it.     The  child  wears  no  clothing  at  all  except 


Fig.  78. — Apparatus  for  feeding  weakly  infants. 


the  cotton  about  it.  A  diaper  may  be  laid  under  it  or  an 
extra  layer  of  absorbent  cotton  may  be  laid  under  its  seat. 
The  room  should  be  kept  warm,  and  especially  so  when 
this  human  bundle  is  unwrapped  for  its  bath.  After 
bathing  it  should  be  rubbed  with  sweet  oil  and  be  rolled 
up  again  in  fresh  cotton.  Often  it  is  better  to  omit  all 
bathing,  and  simply  to  rub  with  the  oil.  Nourishment 
must  be  given  every  hour  in  small  quantities.  If  the 
child  is  too  weak  to  suck,  as  is  usualh'  the  case,  it  should 
be  fed  from  a  spoon  or  a  medicine-dropper,  or,  better  still, 
with  such  an  apparatus  as  is  shown  in  the  illustration 
(Fig.  78).  This  can  be  readily  made  by  any  druggist. 
Sometimes  it  is  necessary  to  nourish  it  through  a  long 
elastic  tube  passed  through  the  mouth  into  the  stomach. 


THE   SICK  BABY.  339 

Rickets. — A  disease  characterized  by  impairment  of 
the  general  health,  but  especially  by  imperfect  develop- 
ment of  the  bones.  It  is  commonest  between  the  ages  of 
six  months  and  three  years.  Among  the  causes  are  in- 
sufficient clothing,  damp  or  ill-ventilated  dwellings,  a 
lack  of  outdoor  air,  and  inherited  weakness  of  constitu- 
tion; but  the  chief  cause  is  some  defect  in  the  character 
of  the  food.  Babies  fed  on  healthy  breast-milk  are  not 
liable  to  develop  rickets,  but  we  must  be  sure  that  the 
milk  is  actually  healthy.  Thus,  for  instance,  too  long 
deferring  of  weaning  may  cause  the  disease  by  rendering 
the  milk  of  insufficient  strength.  Babies  fed  on  con- 
densed milk  are  exceedingly  prone  to  develop  it,  however 
well  the  food  has  seemed  to  agree.  Children  are  very 
likely  to  become  rickety  who  have  constantly  suffered 
from  disturbances  of  the  stomach  and  bowels,  the  result 
of  an  unsuitable  diet. 

The  first  symptoms  in  well-marked  cases  are  free  per- 
spiration about  the  head  while  the  child  is  asleep,  restless- 
ness, tossing  off  of  the  bed-clothes,  distention  of  the  abdo- 
men with  gas,  and  sometimes  a  disposition  to  cry  when 
picked  up,  the  last  being  due  to  tenderness  about  the 
ribs.  These  early  symptoms  are  very  important,  inas- 
much as  prompt  treatment  may  arrest  the  disease  before 
it  advances  further.  A  little  later  there  will  be  decided 
enlargement  of  the  joints,  especially  of  the  wrists  and  of 
the  junctions  of  the  ribs  with  the  cartilages  in  front. 
The  latter  produces  a  row  of  little  prominences  running 
from  above  downward  outside  the  nipple  on  each  side  of 
the  chest.  This  is  often  called  the  "rickety  rosary," 
from  its  resemblance  to  a  string  of  large  beads.  It  can 
be  felt,  and  in  severe  cases  seen  as  well.  The  head  is 
enlarged  and  square,  with  a  projecting  forehead  and  flat 
sides  and  top.      The  fontanelle  remains  open,  and  by  the 


340  THE    CAKK    OF   THE   BABY. 

age  of  a  year  or  over  may  be  even  larger  than  at  birth. 
The  teeth  are  late  in  appearing,  and  there  may  be  none 
at  the  age  of  one  year.  They  often  decay  very  early. 
The  mnscles  are  weak  and  the  bones  soft,  and  as  a  re- 
sult deformities  are  produced.  Bow-legs  or  knock-knees 
often  develop,  and  the  chest  acquires  in  its  trans- 
verse circumference  a  peculiar  violin-shape  with  the 
smaller  end  in  front,  a  groove  on  each  side  running 
longitudinally  from  top  to  bottom,  and  a  decided  promi- 
nence of  the  breast-bone.  With  this  is  combined  very 
often  a  marked  enlargement  of  the  abdomen.  Lateral 
curvature  of  the  spine  in  young  children  is  usually  due 
to  rickets.  The  long  posterior  curvature  has  already 
been  alluded  to  (p.  303).  The  accompanying  illustration 
of  a  mild  case  of  rickets  (PI.  IV.)  shows  the  enlarged 
abdomen  and  wrists,  and  to  some  extent  the  narrowing 
of  the  chest. 

Children  with  rickets  are  often  fat,  and  we  should  there- 
fore have  no  false  sense  of  security  because  there  has 
been  no  loss  of  weight.  They  are  also  peculiarly  liable 
to  suffer  from  colds  in  the  chest,  convulsions,  and  catarrh 
of  the  bowels. 

The  principal  treatment  of  rickets  is  preventive. 
Plenty  of  the  best  nourishment,  a  life  largely  in  the  open 
air  and  sunlight,  daily  immersion  in  the  bath,  and  prompt 
attention  to  any  disturbance  of  the  stomach  and  bowels 
will  usually  avoid  any  danger.  If  symptoms  appear,  there 
is  something  hygienically  wrong,  which  must  be  searched 
out.  The  food  must  be  made  even  more  nutritious,  yet 
digestible.  Raw-beef  juice  is  often  useful.  A  change 
of  air,  especially  to  the  sea-shore,  may  do  much  toward 
the  recovering  of  the  lost  health.  Cod-liver  oil  and  daily 
salt  baths  (Appendix,  49)  are  the  best  remedies.  All 
attempts  of  the  child  to  stand  should  be  discouraged,  as 


Plate  IV. 


Child  with  well-developed  rickets  suffering  also  from  chicken-pox,  showing  the  contracted 
chest,  swollen  abdomen,  and  enlarged  wrists  of  the  first  disease,  and  the  characteristic  rash 
of  the  second.     (From  a  photograph.) 


THE   SICK  BABY.  34 1 

bending  of  the  legs  is  liable  to  follow.  It  is  hardly  neces- 
sary to  say  that  the  treatment  of  a  disease  as  serious  as 
this  must  be  guided  by  a  physician. 

Scrofula. — The  term  scrofula  is  seldom  used  now  in 
the  sense  in  which  it  was  formerl}',  to  designate  a  dis- 
tinct, independent  disease.  Most  of  the  different  ailments 
once  called  by  this  name  are  in  reality  only  manifesta- 
tions of  tuberculosis  in  different  parts  of  the  body.  It  is 
a  mistake  to  call  the  delicate,  flabby  children  with  en- 
larged glands  and  sore  eyes  "  scrofulous."  Some  of  them 
are  tubercular,  some  syphilitic,  and  some  owe  their  ail- 
ments to  other  causes.  The  term,  if  used  at  all,  should 
be  applied  only  to  tubercular  inflammation  of  the  glands 
of  the  neck,  or,  perhaps,  more  widely  to  children  who 
have  a  tendency,  possibly  inherited,  to  develop  tubercular 
affections.  But  even  this  use  is  questionable,  and,  owing 
to  the  confusion  which  exists  about  the  proper  employment 
of  the  word,  it  would  be  better  to  abandon  it  altogether. 

Rheumatism. — The  disease  may  show  itself  as  a  severe 
acute  inflammation  of  many  of  the  joints  of  the  body, 
with  high  fever  and  extreme  pain  on  the  slightest  move- 
ment ;  as  a  slighter  and  more  chronic  inflammation  of 
only  one  or  a  few  joints,  which  become  more  or  less  red, 
tender,  and  swollen  ;  as  a  stiffness  and  soreness  of  son'ie 
of  the  muscles  ;  or,  finally,  in  some  other  more  unusual 
way,  as  in  the  heart  or  the  nervous  system.  It  is  much 
more  frequent  in  children  than  is  commonly  supposed, 
but  is  very  uncommon  in  infants.  Most  of  the  attacks 
of  persistent  pain  in  the  legs  in  infants  under  two  years  of 
age  are  dependent  on  scurvy.  Even  the  mildest  form  of 
articular  rheumatism  may  be  followed  by  St.  Vitus'  dance 
or  by  heart  disease.  The  latter  is  more  liable  to  follow 
rheumatism  in  children  than  in  adults.     It  is,  indeed,  at 


342  THE    CAKE    OF  THE  BABY. 

times  the  first  and  the  only  symptom  of  the  rheumatic 
state,  and  there  may  be  no  articular  pain  at  all.  In  older 
children  the  pains  in  the  joints,  which  are  often  called 
"growing  pains"  or  are  attributed  to  sprains,  and  looked 
upon  as  matters  of  no  consequence,  may  really  be  due  to 
rheumatism  or  to  hip-joint  disease.  The  diagnosis  is  so 
important  that  medical  advice  is  recommended  in  all 
doubtful  cases,  and  certainly  in  those  which  are  clearly 
rheumatic. 

A  child  with  even  a  slight  attack  of  rheumatism  of  the 
joints  is  better  kept  at  rest  in  bed,  in  order  to  ward  off  a 
rheumatic  inflammation  of  the  heart  by  throwing  as 
little  work  on  that  organ  as  possible.  The  food  should 
be  light  and  easily  digestible,  and  meat  should  be  avoided 
to  a  great  extent  or  entirely.  All  exposure  to  chill  must 
be  prevented,  and  the  inflamed  parts  should  be  wrapped 
in  cotton-wool  or  flannel. 

Scurvy. — In  infants  this  disease  often  simulates  cer- 
tain others  very  closely,  particularly  rheumatism  and 
paralysis.  The  patient,  usually  an  infant  of  from  twelve 
to  eighteen  months  or  less,  suffers  from  pain  in  the  ex- 
tremities, particularly  the  legs,  of  so  severe  a  nature  that 
the  child  cries  out  if  they  are  handled,  and  will  not 
voluntarily  move  them  at  all.  With  this  in  bad  cases  are 
associated  a  dropsical  condition  of  the  limbs,  and  often 
general  pallor.  The  gums  frequently  become  swollen  and 
purple  and  bleed  easih*.  This  symptom  is  very  charac- 
teristic when  present.  The  cause  is  always  something 
wrong  with  the  food  given.  IMost  often  it  occurs  in  chil- 
dren who  are  using  some  one  of  the  commercial  patented 
foods.  The  treatment  consists  in  correcting  the  fault  in 
the  diet,  and  in  giving  fresh  fruit  juice  of  a  nature  suited 
to  the  age  of  the  patient. 


THE   SICK  BABY. 


343 


Enlarged  Glands  ;  Adenitis. — The  glands  in  the  neck 
or  elsewhere  may  enlarge,  and  can  then  be  felt  as  larger 
or  smaller  movable  and  somewhat  tender  lumps  below 
the  skin.  If  the  inflammation  in  them  is  intense,  they 
grow  larger  still,  become  red  and  soft  and  filled  with  pus, 
and  finally  burst.  When  they  show  a  tendency  to  per- 
sist, to  increase  in  size  and  number,  and,  it  may  be, 
slowly  to  suppurate  one  after  another,  the  suspicion 
arises  that  tuberculosis  is  the  cause.  The  suddenly- 
developing  inflammations  are  generally  due  to  an  acute 
irritation  somewhere,  not  of  a  tubercular  nature.  For  in- 
stance, enlargement  of  the  glands  below  the  jaw  is  often 
the  result  of  inflammation  in  the  mouth,  and  occurs  in 
diphtheria  and  scarlatina  because  the  mouth  and  throat 
are  affected.  Enlarged  glands  at  the  back  of  the  neck 
follow  irritation  of  the  scalp  by  eczema  or  other  cause  ; 
those  below  and  behind  the  ear  result  from  irritation  of 
the  ears  or  swelling  of  the  tonsils,  or  frequently  accompany 
measles  and  German  measles  ;  those  in  the  armpit  may 
be  the  result  of  some  sore  upon  the  hand,  chest,  or  arm  ; 
and  those  in  the  groin  may  follow  a  similar  condition  of 
the  lower  extremity.  Usually  the  swellings  disappear 
very  soon  after  the  cause  is  removed.  The  disappearance 
may  be  aided  by  rubbing  them  gently  twice  a  day  with 
soap  liniment.  Sometimes,  however,  the  swelling  is  very 
obstinate,  or  may  go  on  rapidly  to  form  an  abscess.  As 
a  rule,  only  one  gland  is  involved  in  such  cases.  In  any 
case  where  the  swelling  does  not  disappear  promptly  a 
physician  should  be  consulted,  as  the  trouble  may  be  of 
a  serious  nature. 

Heart  Disease. — The  recognition  of  disease  of  the  heart 
in  children  is  usually  impossible  by  the  mother.  Severe 
cases   exhibit   great   shortness    of   breath,    making   the 


344  77//?   CARE    OF  THE   BABY. 

child  unable  to  lie  down,  very  forcible  pulsation  over  the 
region  of  the  heart,  a  livid  tint  to  the  skin,  especially  of 
the  lips  and  fingers,  and  a  dropsical  condition  of  the  body, 
especially  of  the  feet.  It  is  the  milder  cases,  however, 
which  are  so  often  overlooked  until  it  is  too  late  for  the 
phwsician  to  be  of  an}-  great  service.  Such  a  child  is  apt 
to  be  decidedly  paler  and  more  delicate  than  there  seems 
any  reason  for,  and  especially  to  have  some  shortness  of 
brcatJi  oil  excrtio7i.  This  is  chiefly  evident  in  the  fact 
that  the  child  is  indisposed,  for  some  reason  not  known 
to  himself,  to  take  much  physical  exercise.  If  a  boy,  he 
finds  that  he  cannot  run  as  fast  or  as  far  as  other  boys, 
and  consequently  chooses  the  quiet  games  favored  by 
girls.  He  is  indisposed  to  climb  the  stairs,  and,  in  fact, 
seems  inactive  without  being  ill.  In  some  cases  there  is 
a  tendency  to  faintness  at  times,  or  a  slight  cough,  palpi- 
tation, pain  over  the  heart,  or  disturbance  of  digestion  ; 
but  these  are  very  inconstant  S}niptoms.  All  symptoms 
may  disappear  when  the  child  is  in  the  best  general  con- 
dition, and  reappear  only  if  he  is  complaining  in  some 
other  way. 

The  importance  of  an  early  recognition  of  the  disease 
is  enormous.  No  mother  wishes  to  be  unduly  anxious 
about  her  child.  At  the  same  time,  the  pcrsistoicc  of 
such  vague  symptoms  as  described,  and  especially  of  the 
evidence  of  shortness  of  breath,  should  lead  her  to  have 
an  examination  of  the  child's  heart  made  by  a  physician 
in  order  to  begin  treatment  at  once,  in  case  any  evidences 
of  disease  are  found  by  him. 

Marasmus. — This  term,  as  commonly  used,  does  not 
indicate  any  distinct  disease,  but  rather  a  progressive 
wasting  or  "  fading  away  "  of  the  body.  The  child  be- 
comes excessively  thin,  is  pale  and  often  sallow,  its  face 


THE  SICK  BABY.  345 

Is  wrinkled,  and  its  flesh  hangs  on  its  bones.  Viewed 
in  the  widest  sense  tlie  canses  are  various,  among  them 
being  tuberculosis,  syphilis,  chronic  vomiting,  persistent 
although  slight  diarrhoea,  and  food  which  is  inadequate 
in  quality  or  quantity.  In  nearly  every  case  a  physician 
can  discover  the  cause,  and  often  can  remedy  it. 

Inflammation  of  the  Breasts. — lu  both  boy  and  girl 
babies  a  day  or  two  old  the  breasts  are  very  apt  to  swell, 
to  become  tender,  and  to  secrete  a  milk-like  fluid.  If 
they  are  let  alone,  the  trouble  disappears  in  one  or  two 
weeks.  If  the  swelling  is  very  decided  and  the  breasts 
are  red,  wet  dressings  will  be  of  service,  but  the  physician 
in  attendance  must  take  charge  in  such  cases.  Some 
ignorant  nurses  have  the  habit  of  squeezing  the  breasts 
of  newborn  children  in  order  to  empty  them  well  or,  in 
the  case  of  girl  babies,  to  favor  a  good  development  later 
in  life.  Such  a  procedure  is  unnecessary  and  harmful  in 
the  extreme,  and  may  readily  produce  an  abscess. 

Hiccough. — Although  seldom  of  any  serious  impor- 
tance, this  may  be  very  annoying.  It  consists  of  a  spas- 
modic contraction  of  the  diaphragm.  It  is  usually 
dependent  upon  some  disturbance  of  digestion,  but  may 
be  due  to  many  other  causes.  In  babies  it  may  often  be 
relieved  by  a  rapid  change  of  position,  patting  the  back, 
or  by  giving  a  little  hot  water,  perhaps  with  soda  mint 
(Appendix,  105).  In  the  case  of  older  children  the 
drinking  of  a  glass  of  water,  the  holding  the  breath  as 
long  as  possible,  or  causing  the  child  to  laugh  is  often 
effective.    . 

Fever. — Fever  is,  of  course,  only  a  symptom  of  a 
large  number  of  affections.     As  it  often  develops   sud- 


34^  THE    CARE    OF   THE   BABY. 

denly  and  without  other  symptoms,  a  mother  should 
know  some  simple  plan  of  treatment  which  may  do  good 
and  cannot  work  harm,  and  which  she  may  employ  before 
the  physician  arrives.  First  of  all,  the  clinical  thermom- 
eter should  always  be  used  (see  p.  43)  to  determine 
whether  or  not  there  really  is  fever.  A  moist  skin  and 
cool  hands  are  not  always  a  sign  of  the  absence  of  fever, 
any  more  than  hot  head  or  hands  are  a  positive  sign  of 
its  presence.  A  feverish  child  has  usually  little  appetite 
or  power  of  digestion,  and  food  should  be  withheld  or 
be  of  the  lightest  kind.  Milk  is  the  best  thing  under 
most  circumstances,  or  some  such  article  as  milk-toast, 
junket,  arrowroot,  or  light  broth.  If  food  is  vomited, 
the  child  should  have  no  nourishment  at  all.  A  good 
laxative,  such  as  a  full  dose  of  magnesia  or  castor  oil,  is 
always  admissible,  and  a  fever  mixture  (Appendix,  108) 
may  be  given.  Confinement  to  bed  is  desirable.  Other 
children  should  be  kept  away,  both  for  the  sake  of 
quiet  and  to  avoid  danger  of  contagion  should  an  infec- 
tious disease  be  beginning.  A  warm  mustard  bath  (Ap- 
pendix, 41,  46)  is  often  given  to  "  bring  out  the  rash" 
at  the  beginning  of  or  later  in  eruptiveTevers.  We  must 
understand  that  the  so-called  "striking  in"  of  the  rash 
in  many  bad  cases  of  eruptive  fevers  is  not  the  thing 
which  is  doing  harm.  The  rash  may  disappear  because 
the  heart  is  dangerously  feeble,  and  in  that  case  returns 
again  because  the  mustard  bath  has  stimulated  the  circu- 
lation. The  warm  bath  is  excellent  also  for  producing 
perspiration  and  reducing  fever.  If  after  two  or  three 
hours  the  temperature  has  not  been  reduced,  the  extra 
wrappings  used  may  be  removed  and  the  coverings  made 
as  light  as  is  comfortable  to  the  patient.  The  abnormal 
heat  of  the  skin  makes  less  thickness  of  coverings  re- 
quired  than  in  health.     The  child  may  have  water  to 


THE  src/v    BAB  V.  2>47 

drink,  cool  but  not  iced,  freely  in  any  reasonable  qnan- 
tity.  Mothers  err  greatly  in  refnsing  to  give  a  thirsty 
child  water.  Bathing  of  the  head  with  bay  rum  or 
cologne  is  alwaj'S  permissible  if  it  does  not  produce  chil- 
liness. A  cold  wet  cloth  may  be  laid  on  the  head  if 
headache  is  severe. 

Dropsy. — An  accumulation  of  fluid  in  any  part  of  the 
body.  The  condition  may  be  limited  to  one  part,  or 
may  be  general  and  affect  the  whole  surface  of  the  body. 
Tlie  most  frequent  causes  are  disease  of  the  heart  and 
Bright's  disease.  In  the  last  stages  of  chronic,  very  de- 
bilitating diseases,  dropsy  of  the  feet  and  hands  shows 
that  the  end  is  approaching.  Peritonitis  and  disease  of 
the  liver  may  produce  dropsy  of  the  abdominal  cavity. 
Treatment  can  be  conducted  only  by  a  physician. 

Cold  Hands  and  Feet. — This  condition  is  usually  a 
sign  of  imperfect  circulation,  itself  depending  upon  in- 
digestion, general  poor  health,  insufficient  clothing, 
lack  of  exercise,  and  similar  causes.  It  not  infrequently 
develops  shortly  after  the  baby  begins  to  wear  stockings 
and  shoes,  before  it  has  became  accustomed  to  them. 
The  stockings  should  be  warm  and  loose,  and  the  shoes 
large.  The  warmth  of  the  clothing  of  the  whole  body 
ought  to  be  increased,  and  all  other  possible  causes  re- 
moved. Sponging  the  hands  and  feet  with  cold  water 
and  following  this  by  brisk  friction  is  often  a  valuable 
plan,  or  they  may  be  rubbed  daily  with  turpentine,  per- 
haps mixed  with  an  equal  part  of  sweet  oil.  As  children 
cannot  sleep  well  if  the  hands  and  feet  are  cold  at  night, 
a  hot-water  bottle  or  bag  must  be  placed  in  the  bed  if 
other  plans  do  not  suffice.  Feeble  infants  should  have 
mittens  or  stockings  drawn  over  their  hands,  if  cold. 


348  THE   CARE    OF   THE   BABY. 

Retention  of  Urine. — No  urine  may  be  passed  for 
twenty-four  or  even  more  hours  after  birth,  and  yet 
nothing  serious  be  amiss.  If  a  warm  bath  or  a  poultice 
over  the  bladder  does  not  relieve  the  difficulty,  the 
advice  of  a  physician  ought  to  be  asked  promptly,  as 
there  may  be  some  physical  obstruction.  Sometimes  the 
pain  which  passing  water  causes  induces  a  child  to  retain 
the  urine  as  long  as  possible.  Sometimes,  too,  after  a 
severe  attack  of  colic  a  child  is  unable  to  pass  water  for 
perhaps  twelve  hours,  and  suffers  considerable  pain  as  a 
result,  as  shown  by  the  straining  cry  and  the  frequent 
doubling  of  the  legs  upon  the  abdomen.  A  bath  or  a 
poultice  will  probably  produce  a  passage  of  urine.  There 
is  apt  to  be  but  little  urine  passed  at  the  beginning  of 
fever  or  during  severe  diarrhoea.  Such  a  condition  is  a 
matter  of  no  consequence,  so  far,  at  least,  as  the  urinary 
symptoms  are  concerned.  In  acute  Bright's  disease  the 
urine  is  often  smoky  in  appearance  or  of  a  muddy-brown 
color  and  very  scant}'.  This  condition  is  a  very  serious 
one.  It  is  most  apt  to  develop  during  or  after  scarlet 
fever.  A  hot  poultice  should  be  applied  over  the  kidneys 
— that  is,  just  below  the  last  ribs  on  each  side  of  the  spine 
— and  a  doctor  must  be  summoned  at  once. 

Bed-wetting;  Incontinence  of  Urine. — The  habit  of 
wetting  the  bed  at  night  or  the  clothes  by  day  is  a  dis- 
ease^ and  not  a  bad  habit  merely,  and  it  is  an  unwar- 
rantable cruelty  to  punish  a  child  for  it.  There  are  cases 
in  which  threats  or  punishment  may  avail,  but  these  are 
so  rare  that  they  may  be  ignored  for  all  practical  pur- 
poses. The  causes  are  various,  and  the  advice  of  a 
physician  is  always  required,  for  the  matter  is  sometimes 
serious  and  is  always  annoying.  The  only  treatment 
open  to  the  mother  is  to  see  that  the  child  has  a  light 


THE   SICK  BABY.  349 

supper,  is  made  to  pass  its  urine  just  before  going  to  bed, 
drinks  no  fluids  for  some  hours  before  bedtime,  is  taken 
up  frequently  during  the  night  to  empty  its  bladder, 
sleeps  on  the  side  and  not  on  the  back,  and  is  not  too 
warmly  covered.  To  prevent  sleeping  on  the  back  an 
empty  spool  may  be  tied  at  the  middle  of  the  spine  by 
a  tape  going  around  the  waist. 

Pain  on  Passing  Urine. — It  may  happen  that  a  baby 
in  apparently  perfect  health  often  suddenly  begins  to  cry 
bitterly  without  any  discoverable  cause,  continues  this 
for  a  short  time,  and  then  ceases.  There  are  no  other 
symptoms,  but  further  study  shows  that  the  crying 
occurs  only  when  the  urine  is  passed.  The  natural  con- 
clusion is  that  the  passage  is  painful,  and  an  examina- 
tion of  the  parts  should  be  made.  If  nothing  can  be 
found  wrong  anatomically,  it  is  probable  that  the  urine 
is  unusually  irritating.  In  such  cases  an  examination  of 
the  diaper  may  show  a  reddish  or  yellowish  deposit  which, 
when  dry,  can  be  rubbed  between  the  fingers,  and  which 
feels  like  the  very  finest  gravel — as,  indeed,  it  is. 

PJiimosis. — This  term  denotes  the  existence  of  a  lonsf 
and  very  narrow  fore-skin  in  boy  babies,  which  cannot 
be  retracted  so  as  to  expose  completely  the  part  beneath. 
It  always  demands  examination  by  a  physician,  since  the 
retention  of  the  cheesy  secretion  beneath  it  is  liable  to 
make  trouble  if  the  condition  is  neglected.  Sometimes 
circumcision  is  required,  but  often  less  radical  treatment 
is  sufficient.  Occasionally  a  somewhat  analogous  condi- 
tion is  seen  in  girl  infants. 

Leucorrhoea. — A  leucorrhoea  which  may  be  quite  pro- 
fuse is  not  at  all  of  infrequent  occurrence  in  little  girls 


350  THE    CARE    OF   THE   BABY. 

even  in  infancy.  The  knowledge  of  this  fact  may  save 
a  great  deal  of  unnecessary  anxiety.  The  disease  some- 
times comes  from  direct  injury  received,  for  instance, 
from  a  fall  on  a  sharp  object,  or  in  other  ways,  but  much 
oftener  is  the  evidence  of  debility.  It  is  occasionally 
produced  by  thread-worms  which  have  found  their  way 
into  the  passage  from  the  bowel.  Occasionally  it  is  a 
much  more  serious  matter  and  is  distinctly  contagious. 
Treatment  consists  in  great  cleanliness,  the  washing  with 
and  the  injecting  of  a  solution  of  boric  acid  (Appendix, 
79),  and,  in  case  there  is  a  great  deal  of  external  irritation, 
the  application  of  a  boric-acid-aud-zinc  ointment  (Ap- 
pendix, 75)  upon  a  piece  of  lint  folded  and  laid  between 
the  irritated  surfaces.  In  any  obstinate  case — and  the 
disease  is  very  apt  to  prove  so — a  physician  must  be  con- 
sulted. 

The    Blue    Baby;     Congenital    Heart    Disease. — It 

sometimes  happens  that  a  new-born  baby  has  a  bluish 
tinge,  showing  that  the  blood  does  not  circulate  properly 
or  get  enough  oxygen.  This  is  not  infrequent  in  weakly 
babies  who  may,  in  the  first  few  days  after  birth,  have 
had  difficulty  in  getting  the  circulation  established. 
Should,  however,  the  color  persist,  the  heart  is  probably 
diseased.  In  mild  cases  the  blue  tinge  appears  only  when 
the  baby  cries,  but  if  the  disease  is  severe  the  color  is 
more  or  less  constant  and  death  may  take  place  in  a  few 
days  or  months.  In  those  who  live  to  older  childhood, 
or^even  to  grow  up,  there  is  apt  to  be  shortness  of  breath, 
palpitation,  and  a  tendency  to  the  bluish  tinge  either 
constantly  present  or  coming  on  with  exertion  or  with 
any  slight  cold  in  the  chest. 

Snoring;  Mouth-breathing. — These  symptoms  maybe 


THE   SICK  BABY.  35  I 

due  to  overgrown  tonsillar  tissue,  as  already  mentioned, 
or  to  obstruction  to  breathing  through  the  nose  from 
some  other  cause.  An  examination  of  the  throat  and 
nose  should  be  made  by  a  physician  in  every  case,  since 
it  is  important  to  remedy  the  difficulty  as  soon  as  possi- 
ble. Children  who  have  long  been  mouth-breathers  from 
nasal  obstruction  often  acquire  a  characteristic  expres- 
sion of  face  and  an  impairment  of  bodily  and  mental 
development  (Chap.  XI.,  p.  268).  Snoring  in  infancy  is 
not  often  merely  a  habit  ;  but  should  examination  by  a 
physician  show  clearly  that  it  is  so,  and  that  there  is 
absolutely  no  obstruction,  the  infant's  mouth  may  be 
gently  closed  whenever  it  is  found  open  during  sleep.  A 
bandage  may  be  placed  under  the  chin  and  over  the  top 
of  the  head,  and  this  will  serve  the  purpose  even  better. 

Thumb-sucking. — A  great  deal  has  been  written  about 
the  dangers  of  thumb-sucking,  yet  the  habit  is  an  ex- 
ceedingly frequent  one,  and  few  children  seem  to  have 
suffered  from  it  in  the  slightest  degree.  As  there  never 
is  any  advantage  in  the  practice,  it  is  best  not  to  let  it 
begin,  and  certainly  not  to  allow  it  to  advance.  In  the 
case  of  babies  who  have  already  contracted  it,  but  who 
suck  their  thumbs  only  if  not  well  or  if  cutting  a  tooth, 
or  as  a  means  of  quieting  the  nervous  system  when  they 
want  to  go  to  sleep,  there  is  no  cause  for  worry.  The 
habit  will  correct  itself  in  good  time,  or,  if  not,  can  gen- 
erally be  easih-  broken  up.  In  some  cases,  however,  the 
habit  begins  during  the  early  weeks  of  life,  soon  becomes 
inveterate,  and  may  persist  for  years  or  even  into  adult 
life,  the  child  sucking  its  thumb  nearly  continuously, 
wdiether  awake  or  asleep.  A  condition  such  as  this 
demands  active  treatment,  since  there  is  danger  of  the 
jaw  being  permanently  deformed. 


352  THE    CARE    OF  THE   BAIiY. 

The  commonest  deformity  resulting  is  the  V-shaped 
jaw,  in  which  the  middle  of  the  upper  jaw  is  pried  for- 
ward by  the  pressure  of  the  thumb  against  its  edge,  so 
that  it  assumes  a  too  angular  shape.  The  lower  jaw  is 
depressed,  and  the  upper  teeth  grow  forward  like  those 
of  a  rabbit,  and  sometimes  even  the  nose  is  distorted  by 
the  upward  pressure  of  the  thumb  upon  the  palate. 

If  it  is  noticed  that  the  habit  is  being  formed,  the 
thumb  should  be  gently  removed  from  the  mouth  when- 
ever found  in  it,  and  the  child's  attention  directed  to  some- 
thing else.  If  the  habit  has  already  been  contracted,  yet 
is  not  practised  immoderately,  it  is  questionable  whether 
it  is  worth  while  to  bother  about  it  unless  it  tends  to 
persist.  If  treatment  is  required,  as  in  the  persistent 
thumb-sucking  described,  bitter  or  disagreeable-tasting 
substances,  such  as  infusion  of  quassia,  extract  of  aloes, 
or  asafoetida,  may  be  put  upon  the  thumbs.  This  is  of 
no  avail  in  bad  cases,  and  the  only  method  to  be  depended 
upon  is  that  of  forcibly  keeping  the  thumbs  out  of  the 
mouth.  This  may  be  done  by  making  the  sleeves  of  the 
night-dress  extend  considerably  below  the  hands;  or  the 
child  may  have  its  hands  put  into  little  flannel  bags  or 
fastened  to  its  sides  at  night — and  during  the  day,  too,  if 
necessary.  Persistence  in  this  treatment  for  months  is 
sometimes  required. 

Lip-sucking. — Occasionally  infants  develop  the  prac- 
tise of  sucking  the  lower  lip.  Although  it  does  no  par- 
ticular harm,  yet  it  is  an  ugly  habit,  which  persistent 
interruption  will  probably  break  up  without  difficulty. 

Dirt-eating. — It  is  not  unconnnon  for  children  of  two 
or  three  years  to  exhibit  a  fondness  for  eating  earth,  sand, 
plaster  from  the  walls,   and  similar  substances.     Some- 


THE   SICK  BABY.  353 

times  it  is  only  a  morbid  habit  depending  upon  a  disor- 
dered nervous  system.  In  other  cases  it  appears  to  be 
connected  with  indigestion.  Careful  study  may  be  needed 
to  discover  the  cause.  Constant  supervision  and  inter- 
ference, with  appropriate  treatment,  will  generally  soon 
effect  a  cure.  Sometimes,  however,  the  habit  is  difficult 
to  stop. 

Biting  the  Finger-nails. — This  is  a  common  habit  in 
children  of  two  years  and  older,  and  one  which  often 
persists  into  adult  life  and  ruins  the  shape  of  the  fingers. 
It  is  generally  merely  the  expression  of  an  innate  ner- 
vousness. Many  children  bite  their  nails  only  when 
excited,  while  others — the  most  inveterate  cases — do  it 
even  when  asleep.  In  its  treatment  the  effort  must  be 
made  to  relieve  the  nervous  excitability  by  suitable 
hygienic  measures,  although  this  is  often  a  difficult  mat- 
ter. The  habit  may  sometimes  be  broken  up  by  dipping 
the  fingers  into  a  solution  of  some  bitter  substance,  or, 
when  this  fails,  by  forcibly  keeping  them  from  the  mouth, 
as  in  the  case  of  thumb-sucking. 

Defective  Speech  (Stammering,  Stuttering,  Lisp- 
ing.— The  terms  stammering  and  stuttering  dXQ.  generally 
used  interchangeably,  although  they  are  not  identical  in 
meaning.  Stammering  applies  to  the  affection  of  speech 
in  which  the  child  is  scarcely  able  to  pronounce  words 
at  all.  Stuttering  is  that  in  which  the  child  makes 
sounds  which  it  does  not  wish  to  make,  such  as  the  rapid 
repetition  of  a  consonant  at  the  beginning  of  a  word,  as 
"  p-p"P"p-pi&- "  For  our  purposes  we  may  consider  both 
affections  under  the  title  of  stammerings  and  much  that 
will  be  said  applies  to  lisping  as  well.  The  habit  is 
really  a  nervous  disease,  and  might  have  been  classified 

23 


354  7-//^  CARE  or  THE  baby. 

accordingly.  The  persistent  form  is  not  common  before 
the  age  of  six  years,  is  more  freqnent  in  boys  than  in 
girls,  and  is  sometimes  hereditary.  At  an  age  earlier  than 
this  it  is  more  liable  to  be  transitory,  lasting  a  few  weeks 
or  months,  and  depending  often  on  some  temporary-  distnrb- 
ance  of  the  nervous  system  or  of  the  health  in  general. 
The  most  important  treatment  is  preventive,  but  the  same 
methods  apply  to  those  who  already  have  the  habit.  A 
child  should  be  made  from  the  beginning  to  talk  slowly 
and  deliberately  and  to  pronounce  all  words  ver}'  dis- 
tinctly. In  this  way  it  will  never  find  an\-  words  espe- 
cially difficult.  It  must  be  carefully  kept  from  associa- 
tion with  stammering  teachers,  schoolmates,  or  friends, 
since  its  power  of  imitation  is  so  remarkable.  It  must  be 
maintained  in  the  best  of  health,  avoid  nervous  excite- 
ment, and  never  be  allowed  to  talk  when  in  a  hurry.  If 
there  is  the  slightest  tendency  to  stammer,  the  import- 
ance of  slow  and  exact  speech  is  all  the  greater.  Scold- 
ing for  the  defect,  or  notice  taken  in  a  way  to  embarrass 
the  child,  will  only  make  the  trouble  more  pronounced. 
Exercises  in  breathing  are  very  important,  since  the  dis- 
ease seems  to  depend  in  part  on  lack  of  control  over  res- 
piration. The  taking  of  deep  breaths,  holding  them  for 
a  few  seconds,  and  then  letting  them  out  slowly  or  with 
interruptions  is  very  useful.  This  process  may  be  re- 
peated several  times  a  day.  A  stammering  child  .should 
take  a  full  breath  before  beginning  a  sentence,  and  should 
have  training  of  the  voice  systematically  carried  on.  It 
should  be  practised  in  uttering  the  vowel  sounds  slowly 
and  without  hesitation,  first  in  a  whisper  and  then  out 
loud,  since  the  whispered  voice  is  not  apt  to  be  stam- 
mered. The  sounds  may  then  be  preceded  by  consonants. 
A  single  forcible  expiration  should  be  used  to  pronounce 
each  syllable.     The  use  of  rhythm  is  a  very  great  help. 


THE   SICK  BABY.  355 

Stainiiiering  is  little  likely  to  occnr  when  syllables,  words, 
and  then  sentences  are  pronounced  in  the  slow,  rhythmi- 
cal way  which  one  sometimes  hears  in  schools  when 
children  recite  in  concert.  Stammerers  usually  can  sing 
without  difficulty.  Should  a  child  begin  a  sentence  im- 
properly, it  must  invariably  be  made  to  stop  at  once  and 
to  repeat  it  slowly.  This  necessitates  constant  watchful- 
ness, perseverance,  and  patience  on  the  part  of  the 
mother,  for  recovery  will  probably  be  slow.  There  are 
institutions  for  the  cure  of  stammering,  and  children 
who  do  not  improve  at  home  should  be  sent  to  some 
good  one  of  this  sort. 

Holding  the  Breath  ;  Spasm  of  the  Larynx. — This, 
like  the  preceding,  is  a  nervous  disease  rather  than  a 
habit.  After  great  excitement,  the  act  of  swallowing, 
exposure  to  a  draught  of  air,  or  a  paroxysm  of  crying 
which  is  often  the  result  of  fright  or  anger  a  child 
may  suddenly  stop  breathing  until,  in  severe  cases,  it 
grows  blue  in  the  face  and  is  nearly  unconscious.  A 
crowing  inspiration  sometimes  attends  the  return  of 
breathing.  In  other  cases  no  occasion  for  the  attack  can 
be  discovered.  The  affection  is  the  result  of  a  sudden  spas- 
modic closing  of  the  larynx  dependent  upon  the  great 
nervous  excitement.  It  is  generally  not  at  all  a  serious 
matter,  although  in  rare  cases  it  may  pass  into  general 
convulsions  or  terminate  in  death  from  suffocation.  If 
the  attacks  are  of  frequent  occurrence  or  severe,  we  should 
suspect  that  the  child  has  rickets  or  some  other  constitu- 
tional disease.  Sudden  slapping  of  the  face  with  a  cold 
wet  towel  or  the  dashing  of  cold  water  into  it  from  a  glass 
is  the  best  immediate  treatment.  The  shock  of  this  pro- 
cedure makes  breathing  recommence.  Medicines  which 
are  sedative  to  the  nervous  system  may  be  needed. 


356  THE   CARE    OF   THE   BABY. 

Stooping;  Round  Shoulders. — The  habit  of  stooping, 
with  the  consequent  development  of  rounded  shoulders, 
depends  on  various  causes.  Sometimes  the  character  of 
the  chairs  used  tends  to  produce  it.  In  other  cases  the 
heiglit  of  the  table  or  desk  from  which  the  child  studies 
is  at  fault.  Not  infrequently  near-sightedness  makes  the 
child  stoop  to  see  better  when  reading  or  writing.  A 
beginning  disease  of  the  spine  may  be  the  occasion.  In 
very  many  cases  it  is  a  habit  depending  upon  general  de- 
bility. The  treatment  consists  in  removing  the  cause, 
and  in  continually  checking  the  disposition  to  stoop. 
Shoulder-braces  are  sometimes  employed.  They  do  good 
more  as  a  reminder  than  in  any  other  way.  Plenty  of 
outdoor  active  play,  and  such  gymnastic  exercises  as 
strengthen  the  back  and  develop  the  chest,  should  be  in- 
sisted upon. 

Masturbation  ;  Self-abuse. — The  habit  may  be  begun 
by  sn]all  children,  or  even  by  infants,  both  bo\'s  and  girls. 
Sometimes  some  local  irritation  is  at  fault,  such  as  phimo- 
sis, worms  in  the  bowel,  inflammation  of  the  vagina  or 
abnormal  adhesions  there,  and  similar  causes.  In  infants 
constant  supervision  must  be  given,  the  hands  being 
forcibly  restrained  if  need  be.  Especial  watch  should  be 
kept  over  girl  infants  against  the  habit  of  "  thigh  fric- 
tion," in  which  the  infant  irritates  the  genitals  by  rub- 
bing them  between  the  inner  surface  of  the  thighs.  In 
older  children  the  habit  is  sometimes  the  result  of  the  in- 
fluence of  evil  companions.  In  these  cases  remonstrance 
and  judicious  explanation  may  avail,  and  especially  the 
constant  but  entirely  unobtrusive  watching  of  the  child, 
who  should  be  kept  as  much  as  possible  in  the  company 
of  the  mother  or  nurse,  and  observed  particularly  while  in 
bed,  at  the  water-closet,  or  in  other  places  where  usually 


THE  SICK  BABY.  357 

left  alone.  Great  judgment  is  required  to  choose  when  to 
io-nore  and  when  to  remonstrate.  Medical  advice  should 
be  had  in  bad  cases,  and  an  examination  for  local  causes 
made. 

(7)  ACCIDENTS  AND  EMERGENCIES. 

Cuts  and  Tears. — A  n//,  or  incised  woiiiid^  is  made  by 
some  sharp  cutting  instrument.  If  deep  or  extensive,  or 
if  bleeding  very  freely,  it  should  have  surgical  attention 
at  once.     A  small  cut  which  can  be  dressed  at  home 


Fir,    79. — Roller  bandage,  showing  the  method  of  making  the  "  reverses." 

should  be  washed  gently  but  thoroughly  with  absorbent 
cotton  and  cold  or  very  hot  water  (which  will  both 
cleanse  it  and  help  to  arrest  the  bleeding)  and  then  with 
an  antiseptic  solution,  such  as  a  carbolic-acid  lotion 
(Appendix,  Si)  or,  still  better,  one  of  corrosive  sublimate 
(Appendix,  82).  A  compress  made  of  clean  folded  linen  or 
muslin  wet  with  the  solution  should  now  be  placed  over 
tlie  wound  and  bound  on,  not  too  tightly,  with  a  rollei 
bandage.  The  dressing  may  be  left  on  unchanged  for 
days  if  it  keeps  perfectly  sweet-smelling  and  the  child  is 
not  feverish  or  in  pain.  The  illustration  (Fig.  79)  shows 
the  different  steps  in  the  application  of  a  roller  bandage. 
The  half  turn,  technically  known  as  the  reverse,  makes 
the  bandage  lie  smooth  and  close  to  the  limb. 

If  the  wound  secretes  pus,  the   old  dressing  must  be 


35^  THE    CARE    OF   THE  BABY. 

soaked  in  the  antiseptic  solution  until  it  comes  away 
easily  and  without  pulling,  the  wound  then  washed  with 
the  solution,  and  a  fresh  dressing  applied.  This  may 
have  to  be  done  daily  if  pus  continues  to  appear.  We 
must  never  forget  that  both  the  carbolic-acid  and  the 
corrosive-sublimate  solutions  are  poisonous  if  swallowed. 
If  the  bleeding  will  not  stop,  the  bandage  must  be 
applied  with  moderate  firmness,  or  pressure  be  made  with 
a  finger,  and  a  surgeon  called  in.  If  the  blood  spurts  out 
of  the  wound  in  jets,  an  artery  has  been  injured.  Bleed- 
ing from  this  or  from  any  other  wound  can  always  be 
stopped  until  the  doctor  arrives  by  making  pressure  with 
the  fingers  directly  into  the  wound.  The  pressure  must 
be  constant,  and  not  relaxed  every  few  minutes  to  see  if 
the  flow  has  ceased.  The  use  by  others  than  physicians 
of  what  is  called  a  tourniquet — such,  for  instance,  as  a 
twisted  handkerchief  or  a  cord  tied  tightly  around  the 
arm  or  the  leg — is  not  only  very  painful,  but  is  dan- 
gerous also,  since  it  may  cause  serious  injury  of  the 
tissues. 

Should  a  child  chance  to  have  a  finger  cut  off',  this 
should  be  immediateh'  washed  carefully  and  fastened 
firmh^  in  place  again  with  adhesive  plaster,  and  a  physi- 
cian sent  for.  It  sometimes  happens  that  the  severed 
portion  will  grow  fast. 

A  tear^  or  lacerated  ivound^  is  produced  by  some  dull 
body,  such  as  a  nail  or  a  brick.  It  has  ragged  edges  and 
does  not  often  bleed  much.  Unless  very  small,  a  physi- 
cian should  treat  it,  since  wounds  of  this  sort  are  more 
likely  to  leave  scars.  A  small  tear  must  be  cleansed 
carefully  with  lukew^arm  water  followed  by  an  antiseptic 
solution  (Appendix,  79-82),  as  it  is  very  apt  to  have 
dirt  in  it.  The  torn  edges  should  be  brought  together  as 
well  as  possible,   and  the  wound  covered  with   a   com- 


THE   SICK  BABY.  359 

press  wet  with  the  antiseptic  fluid  and  bandaged  up 
loosely.  The  dressing  must  be  renewed  every  day  if  it 
becomes  soiled  with  pus,  following  the  method  just  de- 
scribed for  cuts.  If  it  remains  unsoiled,  it  may  be  left  on 
until  the  wound  is  nearly  healed.  The  small  sore  which  is 
left  may  be  dressed  several  times  a  day  with  a  zinc-and- 
boric-acid  ointment  (Appendix,  75)  spread  on  a  small 
piece  of  lint.  This  ointment  is  also  very  useful  for  cases 
in  which  the  skin  has  been  partly  scraped  off — as,  for  in- 
stance, when  the  head  or  the  knee  has  been  scraped 
along  the  ground. 

Punctured  Wounds  ;  Splinters. — Punctured  wounds 
are  those  made  by  sharp-pointed  objects,  such  as  pins, 
needles,  fish-hooks,  tacks,  splinters,  and  the  like.  They 
are  often  painful  and  attended  by  a  good  deal  of 
swelling.  The  object  must  be  removed  and  the  injured 
part  squeezed  gently  in  warm  water  in  order  to  favor  the 
flow  of  blood,  which  will  help  to  wash  away  the  im- 
purities which  may  have  entered.  If  there  is  a  tendency 
to  swelling,  a  warm  antiseptic  poultice  may  be  applied 
(Appendix,  66). 

In  case  a  needle  has  entered  and  remained  in  the  flesh, 
great  care  should  be  taken  not  to  break  it  in  attempting 
to  remove  it,  and  it  should  be  closely  examined  after 
removal  to  see  that  it  is  quite  intact.  If  it  has  been 
broken,  a  surgeon  must  be  called  in  and  the  fragment 
saved  to  show  him. 

Fish-hooks  which  have  entered  beyond  the  barb  must 
either  be  cut  out  or  be  pushed  through  the  skin  from 
inside,  but  never  torn  out. 

If  any  portion  of  a  splinter  is  protruding,  it  may  be 
seized  with  small  pliers  or  tweezers  and  be  pulled  out, 
care  being  taken  to  avoid  any  side  motion,  lest  the  wood 


^^ 


360  7V/£    CARE    OF  THE   BABY. 

break  off.  If  it  cannot  be  removed  in  this  way,  it  may, 
perhaps,  be  picked  out  with  a  needle.  Should  a  splinter 
too  short  to  grasp  have  lodged  beneath  the  finger-nail, 
the  nail  should  be  carefully  scraped  very  thin  over  it  and 
then  be  split  open  with  the  point  of  a  sharp  knife,  just 
enough  to  allow  of  the  top  of  the  piece  of  wood  being 
seized.  This  is  not  as  difficult  as  it  sounds,  and  gener- 
ally causes  very  little  pain.  If  efforts  to  remove  a  splin- 
ter fail  and  a  physician  cannot  be  had,  the  part  should  be 
poulticed  until  pus  forms,  when  the  splinter  will  probably 
come  out  with  it. 

Poisoned  Wounds. — hisect-sti7igs  belong  to  the  class 
called  poisoned  wounds.  They  are  seldom  dangerous, 
although  for  a  time  quite  painful.  Careful  examination 
may  show  the  sting  of  the  insect  still  in  the  wound.  It 
should  be  pulled  out  with  tweezers,  and  water  of  ammo- 
nia or  spirits  of  camphor  applied.  A  cold-water  dressing 
may  then  be  employed  to  prevent  swelling.  The  appli- 
cation of  mud  is  as  useful  as  it  is  old-fashioned. 

Mosquito-bites  are  of  this  same  class.  They  are  often 
a  source  of  great  annoyance  and  disfigurement  to  chil- 
dren. The  best  procedure  is  to  keep  the  little  pests  away 
by  having  screens  fitted  to  the  windows  and  doors,  or  a 
large  canopy  over  the  bed.  A  small  canopy  tends  to 
shut  out  the  air  too  much.  The  anno}ing  itching  may 
be  allayed  by  touching  the  bites  with  carbolized  oil  (Ap- 
pendix, 76),  ammonia,  or  spirits  of  camphor,  or  with  a 
cooling  evaporating  lotion  (Appendix,  89).  Dampened 
salt  rubbed  on  the  spot  is  sometimes  useful. 

Dog-bites  or  the  bites  of  other  animals,  as  the  cat  or 
rat,  are  sometimes  productive  of  severe  inflammation, 
and  even  of  decided  illness.  It  is  rare,  however,  that 
hydrophobia  follows.     The  dog  which  has  bitten  any  one 


THE  SICK'  BABY.  36 1 

should  on  no  account  be  killed  until  it  lias  been  kept 
long-  enough  to  determine  whether  or  not  it  was  mad. 
To  find  that  the  animal  was  not  rabid  will  be  a  great 
relief  to  all  concerned.  Wounds  produced  by  the  bite 
of  an  animal  should  be  pressed  out  thoroughly  under 
warm  water  or  be  well  sucked.  They  may  then  be 
covered  with  a  cold  wet  dressing.  If  the  bite  is  that  of 
a  dog  undoubtedly  mad,  the  part  must  be  cut  out  quickly 
or  be  cauterized  deeply  with  a  red-hot  iron  or  with  strong 
carbolic  or  some  mineral  acid,  such  as  sulphuric  or  nitric. 
Snake-bites  constitute  a  variety  of  poisoned  wounds 
fortunately  not  often  met  with  in  this  part  of  the  world. 
If  the  snake  was  a  venomous  one,  a  cord  should  at  once  be 
tied  around  the  limb  above  the  wound  to  stop  the  prog- 
ress of  the  blood  and  to  keep  the  poison  out  of  the 
general  circulation.  The  wound  should  be  squeezed  out 
under  water,  or  may  be  sucked  thoroughly,  provided  the 
lips  of  the  person  who  does  this  are  quite  free  from 
cracks.  It  ought  then  to  be  cut  out  or  cauterized  as  in 
the  case  of  dog-bites.  Stimulants  in  large  quantity  have 
been  recommended,  and  are  perhaps  of  service.  A  solu- 
tion of  permanganate  of  potash  of  the  strength  of  20 
grains  to  the  ounce  should  be  used  to  wash  the  wound. 

Bruises. — Bruises  or  contusions  generally  do  little 
damage  other  than  temporarily  to  disfigure.  A  painful 
swelling  develops,  rapidly  increases  in  size,  and  turns 
deep  purple  as  the  result  of  the  escape  of  blood  under  the 
skin.  This  color  gradually  passes  through  different 
shades  of  green  and  yellow  until  the  blood  has  been 
absorbed.  To  prevent  the  swelling  and  discoloration  to 
any  degree  the  treatment  must  be  begun  at  once.  Firm 
pressure  may  be  kept  up,  or  compresses  wet  with  ice- 
water,  very  hot  water,  or  alcohol  and  water  continuously 


362  THE   CARE    OE   THE   BABY. 

applied.  The  colorless  fluid  extract  of  witch  hazel  put 
on  at  once  on  a  compress  is  excellent  treatment.  A 
25  per  cent,  ichthyol  ointment  is  another  popular  appli- 
cation. If  discoloration  has  occurred,  its  disappear- 
ance may  be  hastened  by  rubbing  the  bruise  with 
lanolin. 

Sprains. — A  twisting  or  straining  of  a  joint,  or  3.sprai7i^ 
produces  great  pain  on  motion,  rapid  swelling,  and 
often  a  discoloration  of  the  skin  like  that  of  a  bruise. 
Although  in  many  instances  sprains  are  slight  and  are 
quite  well  in  a  few  days,  in  some  severe  ones  recovery  is 
very  slow  and  the  bad  effects  are  more  lasting  than  in  the 
case  of  broken  bones.  Every  sprain  except  the  very 
mildest  should  have  a  physician's  attention  as  early  as 
possible.  If  this  cannot  be  procured,  the  joint  should  be 
soaked  in  hot  water  and  then  be  put  at  absolute  rest.  If 
it  is  the  ankle  or  the  knee  which  is  injured,  the  child 
must  be  kept  in  bed  with  the  part  elevated  and  covered 
with  a  dressing  of  cold  water  or  of  witch  hazel.  In  the 
case  of  the  arm  the  joint  must  be  kept  quiet  on  a  pillow 
or  supported  on  a  splint  or  in  a  sling  with  the  dressing 
applied.  After  the  acute  pain  and  all  signs  of  inflamma- 
tion have  disappeared — which  is  often  a  matter  of  days 
or  even  of  weeks — the  joint  may  be  rubbed  daily  with 
soap  liniment  or  chloroform  liniment  and  very  carefully 
and  slightly  moved.  A  25  per  cent,  ichthyol  oint- 
ment is  also  a  good  application  for  sprains.  Under 
the  special  supporting  dressings  which  surgeons  employ, 
the  confinement  to  bed  after  sp)rains  of  the  lower  extremi- 
ties is  greatly  curtailed. 

Fractures  and  Dislocations. — In  d/sloca/iojis  the  bones 
which  meet  at  a  joint  become  separated  from  their  nor- 


THE   SICK  BABY.  363 

mal  relation — that  is,  they  are  "out  of  place. "  Disloca- 
tions are  unusual  in  children,  with  the  exception  of  that 
of  the  elbow-joint.  In  a  fracmre  a  bone  is  broken  par- 
tially or  entirely  in  two.  Very  frequently  in  children 
there  is  what  is  called  a  "  green-stick  fracture;"  that  is, 
there  is  a  bending  of  the  bone,  not  a  complete  breaking 
across.  This  is  because  a  child's  bones  are  much  less 
brittle  than  those  of  an  adult.  Fractures  and  disloca- 
tions are  painful,  and  generally  produce  decided  deform- 
ity at  the  time.  The  child  while  being  carried  to  the 
house  or  bed  must  be  handled  most  carefully,  and  the 
part,  especially  if  fractured,  be  always  supported,  since 
the  slightest  motion  of  the  rough  ends  of  the  broken 
bone  gives  agonizing  pain  and  tears  the  flesh  about  them. 
If  the  child  has  to  be  taken  some  distance,  the  limb 
should  be  bandaged  with  handkerchiefs  or  anything  else 
at  hand  to  an  improvised  splint,  such  as  a  piece  of  board 
or  pasteboard,  several  newspapers  folded  so  as  to  give  as 
much  stiffness  as  possible,  or  even  a  couple  of  small 
branches  from  a  tree.  In  a  similar  way  a  broken  leg  can 
be  bandaged  to  the  sound  one,  or  the  arm  to  the  side. 

Burns  and  Scalds. — A  burn  is  the  result  of  contact 
with  a  flame  or  with  dry  heat  of  some  sort,  while  a  scald 
is  produced  by  a  hot  fluid.  For  convenience  we  may 
call  them  both  burns,  for  the  injury  to  the  tissues  is  the 
same  in  each  except  that  the  damage  from  hot  liquids  is 
apt  to  be  less  deep.  The  danger  to  life  from  a  burn  de- 
pends more  upon  its  extent  of  surface  than  upon  its 
depth.  On  the  other  hand,  the  degree  of  subsequent  de- 
formity depends  upon  the  depth  of  the  injury.  If  half  of 
the  surface  of  the  body  is  involved,  the  result  is  nearly 
always  fatal.  In  the  more  superficial  burns  the  skin  is 
reddened  and  perhaps  blistered,  while  in  the  deeper  ones 


364      .  THE    CARE    OF  THE   BABY. 

it  is  yellowish-white  or  blackened.  The  pain  is  usually 
very  severe,  yet  in  the  worst  cases  the  child  may  suffer 
very  little,  but  be  so  alarmingly  prostrated  by  the  shock 
that  it  may  die  in  a  few  hours.  Only  the  small  and 
slight  burns  may  be  treated  by  the  mother.  Pain  must 
be  first  relieved  by  shutting  away  the  air  and  preventing 
the  rubbing  of  the  clothes.  To  accomplish  this  several 
layers  of  soft  linen  cloth  may  be  applied-,  wet  with  a 
strong  solution  of  baking-soda — a  heaping  teaspoonful  to 
a  glass  of  water.  As  soon  as  the  pain  is  allayed,  or  even 
from  the  first  if  not  severe,  the  wound  may  be  dressed 
with  vaseline  or  oxide-of-zinc  ointment  ;  or,  often  still 
better,  a  boric-salicylic-acid  lotion  (Appendix,  80),  or 
boric-acid  ointment  (Appendix,  74),  as  these  make  the 
wound  aseptic.  If  a  child's  clothes  are  on  fire  its  head 
should  be  placed  low,  for  the  flames  naturally  tend  to 
rise,  and  burns  about  the  head  and  hands  are  the  most 
disfiguring.  The  child  should  instantly  be  thrown  upon 
the  floor  and  the  burning  clothes  wrapped  about  with 
some  thick  woollen  material,  such  as  a  piece  of  carpet,  a 
rug,  table-cover,  dress-skirt,  shawl,  or  overcoat,  begin- 
ning always  at  the  neck.  Cotton  and  linen  articles 
catch  fire  too  easily  themselves,  but  even  these  are  better 
than  nothing,  for  if  quickly  applied  they  may  smother 
the  flames  before  they  are  ignited  by  them.  Nothing 
can  be  better  than  a  tub  or  bucket  of  water  dashed  over 
the  child,  if  this  happens  to  be  at  hand.  Running  about 
the  room  or  into  the  open  air  with  the  child  only  fans  the 
fire.  After  the  flames  are  extinguished  stimulants  should 
be  given  if  there  is  much  prostration,  the  child  put  to 
bed  at  once,  and  the  clothing  removed  with  the  greatest 
gentleness  if  it  is  impossible  to  obtain  a  physician  with 
reasonable  promptness.  Frequently  the  garments  must 
be  cut  away  bit  by  bit  in  order  to  avoid  tearing  the  blis- 


THE   SICK  BABY.  365 

ters  which  have  been  produced.  Only  a  small  portion 
should  be  removed  at  a  time,  and  the  burnt  part  exposed 
dressed,  letting  the  rest  stay  covered  in  order  to  reduce 
the  pain  from  exposure  as  much  as  possible.  The 
blisters  may  now  be  pierced  at  the  edge  with  a  clean 
needle,  which  has  been  sterilized  by  holding  it  a  moment 
in  the  flame,  and  the  burnt  parts  covered  with  soft  linen 
cloths  saturated  with  the  boric-salicylic-acid  lotion  (Ap- 
pendix, 80),  or  the  boric-acid  ointment  (Appendix,  74). 
Lastly,  the  whole  should  be  enveloped  in  raw  cotton,  oil 
silk,  or  paraffin  paper,  and  bandaged  loosely  in  order  to 
exclude  the  air  still  more  perfectly.  Hot  bottles  should 
be  applied  to  portions  of  the  body  which  have  not  been 
burnt  if  the  prostration  continues.  The  after-treatment 
will  be  managed  by  the  physician  when  he  arrives. 

Btirns  with  acids  should  have  the  liquid  washed  away 
quickly  with  water  or,  still  better,  with  a  solution  of 
baking-soda.  Burns  with  alkalies^  as  lye,  should  be 
treated  quickly  with  vinegar  and  water.  Each  sort  may 
then  be  dressed  with  oily  applications,  such  as  olive  oil, 
vaseline,  or  zinc  ointment. 

It  must  be  remembered,  however,  that  oily  applica- 
tions used  on  a  burn  of  any  kind  usually  add  to  the 
difficulty  of  making  it  aseptic  when  the  doctor  arrives, 
and  that  an  antiseptic  dressing,  such  as  the  boric-salicylic- 
acid  lotion  referred  to,  is  to  be  preferred. 

Sunburn. — The  open-air  life  so  greatly  to  be  desired  is 
liable  to  cause  sunburn,  which,  if  of  slight  extent,  is  a 
matter  of  little  consequence.  To  be  ruddy  from  the  sun 
is  much  better  than,  from  lack  of  fresh  air  and  sunlight, 
to  look  like  a  potato-sprout  in  a  dark  cellar.  Sunburn 
may,  however,  become  so  severe  that  it  is  actually  pain- 
ful and  demands  treatment.     The  skin  in  such  a  case 


366  THE    CARE    OF   THE   BABY. 

may  not  only  be  reddened  and  tender,  but  blistered  and 
much  swollen  also.  The  simplest  treatment  consists  in 
covering  the  injured  parts  with  oxide-of-zinc  ointment. 

Freckles. — Deposits  of  pigment  in  the  skin  in  the 
form  of  irregularly-shaped  small  blotches,  usually  result- 
ing from  exposure  to  the  sun  or  glare.  They  are  most 
marked  in  blondes,  especially  in  those  with  red  hair  and 
a  very  transparent  complexion.  Brunettes  may  develop 
them  also,  but  are  more  likely  to  have  a  uniform  deposit 
of  pigment;  that  is,  they  become  tanned.  Freckles  are 
not  common  before  the  age  of  three  years,  and  the  tend- 
ency to  develop  them  often  diminishes  after  the  age  of 
puberty.  Although  keeping  a  little  girl  out  of  the  sun 
may  prevent  freckles,  it  would  certainly  injure  her 
health.  The  best  plan  to  avoid  them  is  to  have  the  face 
shielded  by  a  broad-brimmed  hat  and  to  shun  the  most 
intense  glare.  There  are  numerous  applications  recom- 
mended to  remove  them.  Some  of  these  are  much  too 
powerful  to  be  used  except  under  a  physician's  direction. 
This  is  also  true  of  many  of  those  sold  in  the  shops.  A 
preparation  which  may  be  tried  safely  is  a  benzoin  or  a 
borax-and-acetic-acid  mixture  (Appendix,  90,  91). 

Frost-bite ;  Freezing. — The  first  effect  of  long  ex 
posure  to  cold  is  to  make  the  skin,  usually  of  the  fingers, 
toes,  nose,  or  ears,  become  numb,  white,  and  wrinkled. 
Then,  upon  coming  into  a  warm  place,  the  parts  become 
red,  swollen,  and  itching.  If  the  action  of  the  cold  has 
been  severe,  blisters  form  over  the  frozen  skin,  and  finally 
mortification  may  set  in.  Generally,  under  proper  treat- 
ment the  frozen  part  regains  its  sensation  and  becomes 
painful  for  a  time,  the  swelling  disappears,  and  there  is 
no  further  trouble.      In   the    case  of  those  who  have 


THE.  SICK  BABY.  367 

been  nearly  "frozen  to  death"  the  whole  body  is  affected 
by  the  cold  and  there  is  unconsciousness.  In  the  treat- 
ment of  freezing,  the  child  should  be  kept  in  a  cool 
room  for  some  hours  and  the  frozen  parts — or  the  whole 
body,  if  it  is  a  case  of  general  freezing — be  rubbed  with 
cold  water  or  snow  or  wrapped  in  cold  wet  cloths.  A 
25  per  cent,  ichthyol  ointment  may  then  be  applied. 
The  removal  to  a  warm  place  should  be  made  with  the 
greatest  care.  Sometimes  a  frozen  part  may  afterward 
be  subject  to  chilblains. 

Chilblains. — Red,  smooth,  shining  spots  of  different 
sizes  which  itch  and  burn  severely  when  the  parts 
become  warm.  Sometimes  blisters  form,  and  even  ulcers 
if  there  is  much  friction,  as  from  a  shoe.  The  favorite 
positions  are  the  feet  and  hands,  although  the  nose, 
cheeks,  and  ears  are  occasionally  attacked.  Chilblains 
are  particularly  painful  when  upon  the  feet,  after  they 
have  become  warm  in  bed.  They  are  most  apt  to 
develop  in  weakly  children,  especially  in  girls  with  poor 
circulation,  and  are  liable  to  recur  every  year  with  the 
autumn  season  and  to  last  until  warm  weather  returns. 
The  original  cause  consists  in  sudden  alteration  of  the 
bodily  temperature — such,  for  instance,  as  follows  rapid 
warming  of  the  hands  and  feet  at  a  fire  after  prolonged 
exposure  to  wet  or  cold.  Treatment  consists  in  improv- 
ing the  general  health  and  in  dressing  the  feet  with 
broad,  stout,  easy  shoes  and  with  warm  woollen  stock- 
ings with  garters  going  to  the  waist,  or  with  warm  mit- 
tciis  if  the  chilblains  are  on  the  hands.  Frequent  paint- 
ing with  Monsel's  solution  of  iron  or  with  tincture  of 
iodine  is  often  of  great  benefit. 

Concussion  of  the  Brain. — A  serious  disturbance  of 


368  THE    CARE    OF   THE   BABY. 

the  brain  produced  by  a  fall  or  a  blow  upon  the  head, 
and  attended  by  complete  or  partial  loss  of  consciousness 
lasting  for  a  moment  or  for  hours.  The  skin  is  pale  and 
cold,  and  the  piilse  and  respiration  are  feeble.  The  child 
may  seem  merely  stunned,  and  there  may  be  only  vomit- 
ing and  pallor  and  a  bewildered  condition.  As  even  the 
mildest  cases  sometimes  become  serious  later,  every  child 
who  has  exhibited  any  suspicious  symptom.s  after  an 
injury  to  the  head  should  have  medical  advice  as  soon  as 
possible.  Meanwhile  it  should  be  put  to  bed  in  a  dark- 
ened and  very  quiet  room  and  be  warmed  by  hot  bottles 
if  cold,  but  given  no  stimulants  unless  it  is  absolutely 
necessary.  If  it  has  severe  pain  in  the  head,  but  is  not 
cold  or  weak,  an  ice-bag  or  ice-water  compresses  may  be 
applied  to  prevent  the  development  of  inflammation. 

Foreign  Bodies  in  the  Eye. — A  cinder  or  other  minute 
sharp  particle  often  causes  great  irritation  in  the  eye.  If 
rubbing  is  prevented  the  tears  will  often  wash  the  object 
away  in  a  short  time.  If  it  adheres  more  firmly  under 
the  upper  lid,  the  upper  lashes  should  be  seized  with  the 
fingers  and  the  lid  be  pulled  away  from  the  eye  and  well 
down  over  the  lower  lid  and  then  let  go,  when  the  lower 
lashes  may  sweep  the  offending  body  out.  If  this  does 
not  succeed  promptly,  the  eye  must  be  examined.  Pull- 
ing down  the  lower  lid  reveals  its  lining  and  that  of  the 
lower  half  of  the  eyeball,  but  to  examine  the  upper  por- 
tions it  is  necessar)^  to  turn  the  upper  lid  inside  out.  The 
upper  eyelashes  must  be  dried  and  be  seized  between  the 
finger  and  thumb,  the  mother  standing  behind  the  child. 
While  the  child  is  told  to  look  well  downward  a  blunt- 
pointed  object,  as  a  lead-pencil,  is  pressed  against  the 
middle  of  the  upper  eyelid  and  the  lashes  are  pulled  up- 
ward. It  sometimes  takes  several  trials  to  accomplish 
this  (Fig.  80). 


THE   SICK  BABY.  369 

The  foreign  body,  if  found,  should  be  very  gently  re- 
moved with  a  moistened  camel' s-hair  brush.  Irritation 
may  persist  for  some  time,  and  a  simple  eye  lotion  (Ap- 
pendix, 85),  kept  tepid,  may  be  dropped  frequently  into 
the  hollow  between  the  eye  and  the  nose  and  be  allowed 
to  trickle  into  the  eye.  If  the  brush  fails  to  remove  the 
object  or  if  it  cannot  be  found  and  the  irritation  con- 
tinues, a  physician  should  be  consulted. 

Lime  or  acid  in  the  eye  produces  a  great  deal  of  pain. 


Fig.  80. — Method  of  everting  the  upper  eyehd. 

The  eye  should  at  once  have  poured  into  and  over  it  water 
containing,  in  the  first  case,  a  little  vinegar  or  lemon™ 
juice,  a  teaspoonful  to  a  glass,  and  in  the  second  case 
baking-soda,  a  tablespoonful  to  the  glass.  Sweet  oil  is 
also  useful  in  either  case.  A  physician  should  be  con- 
sulted immediately. 

Wounds  of  the  Eye. — The  eyeball  may  be  cut  by 
various  sharp  bodies,  but  the  most  serious  wounds  are 
those  made  by  pointed  instruments,  such  as  scissors, 
forks,  etc.,  which  penetrate  into  its  interior.  Sometimes, 
too,  some  sharp  foreign  body,  as  a  splinter  of  metal  or  of 
stone,  flies  against  the  eye  and  passes  within  it.  The  pro- 
duction of  a  misshapen  pupil  is  proof  that  the  wound  is 
actually  a  penetrating  one.  The  absence  of  this  irregu- 
larity is,  however,  not  an  evidence  of  the  contrary.  A 
penetrating  wound  is  always  serious,  as  it  may  not  only 

24 


370  THE    CARE    OF  THE  BABY. 

cause  the  loss  of  the  injured  eye,  but  may  even  set  up  a 
sympathetic  inflammation  of  the  sound  eye,  and  produce 
blindness  in  it  also.  Professional  aid  must  be  had  at 
once. 

Foreign  Bodies  in  the  Ear. — Children  often  put  peas, 
shoe-buttons,  beads,  and  similar  objects  into  their  ears. 
If  the  object  is  at  all  deeper  in  than  the  opening,  its 
removal  should  be  left  to  a  physician.  Should  no  physi- 
cian be  available,  the  mother  may  try  to  do  something 
herself  The  child  should  be  laid  upon  the  affected  side 
and  the  tip  of  the  ear  be  strongly  pulled  outward  and 
backward,  thereby  straightening  the  canal,  whereupon 
the  object  will  sometimes  drop  out  of  itself  If  it  does 
not,  syringing  with  tepid  water  may  be  employed.  For 
this  purpose  should  be  used  the  little  bulbous  syringe  de- 
scribed on  p.  297.  In  an  emergency  the  syringe  used  for 
giving  enemata  may  be  employed.  The  child  should  be 
seated,  the  ear  drawn  outward  and  backward,  and  the 
nozzle  placed  at  the  upper  part  of  the  opening  of  the 
canal,  in  order  that  the  water  may  get  behind  the  object 
and  wash  it  out  while  returning. 

After  all,  however,  a  foreign  body  in  the  ear  does  little 
harm  as  long  as  it  is  giving  no  pain.  Certainly  there  is 
less  risk  in  leaving  it  there  until  a  convenient  time  comes 
for  having  a  physician  remove  it  than  there  is  in  unskil- 
ful meddling  with  it,  which  may  only  drive  it  further  in 
or  do  harm  to  the  canal  or  the  drum.  Sometimes  an 
insect  crawls  into  the  ear  and  occasions  much  suffering 
by  scratching  against  the  drum-membrane.  Sweet  oil  or 
castor  oil  should  be  poured  in  at  once,  and  the  eai 
syringed  with  water  after  about  half  an  hour. 

Swallowing  of  Foreign  Bodies. — The  swallowing  of 


THE  SICK  BABY.  37 1 

such  articles  as  coins,  marbles,  buttons,  etc.  usually  need 
give  no  anxiety.  It  is  often  advised  to  give  the  child 
plenty  of  potato  or  bread  to  eat,  on  the  ground  that  this 
coats  the  object  and  allows  it  to  pass  from  the  bowel 
without  doing  any  harm.  No  laxatives  are  necessary. 
Sometimes,  however,  the  body,  especially  if  angular 
or  pointed,  such  as  a  fish-bone,  jackstone,  or  pin,  sticks 
in  the  throat  and  causes  choking.  If  this  occur,  the  child 
should  at  once  be  suspended  by  the  feet  and  slapped  upon 
the  back  in  the  effort  to  dislodge  the  object.  If  it  is 
high  in  the  throat,  a  cautious  attempt  should  be  made  to 
grasp  it  with  the  finger  and  thumb.  If  it  has  seemed  to 
stick  some  distance  lower  in  the  passage  to  the  stomach, 
the  child  should  be  made  to  swallow  several  large  mouth- 
fuls  of  soft  food,  which  may  carry  the  body  downward 
with  them.     A  physician  must,  of  course,  be  called  in. 

Foreign  Bodies  in  tlie  Nose. — As  in  the  case  of  the 
ears,  children  often  put  small  objects  into  the  nose  and 
forget  their  presence  or  fear  to  speak  of  it.  At  last  an 
obstinate  inflammation  or  discharge  arouses  the  suspicion 
that  something  is  wrong.  If  the  object  is  not  too  far  in, 
or  is  not  too  firmly  held  by  the  swelling  of  the  mucous 
membrane  or  by  its  own  increase  in  size,  which  the  ab- 
sorption of  moisture  often  produces,  it  may  sometimes  be 
removed  by  having  the  child  blow  its  nose  vigorously  or 
by  tickling  the  nose  or  giving  snuff  to  produce  sneezing. 
If  this  does  not  succeed,  a  physician  should  be  sum- 
moned to  remove  the  object,  since  injury  follows  unskil- 
ful efforts  to  get  it  out. 

Nose-bleed. — Some  children  are  very  liable  to  nose- 
bleed without  any  apparent  reason,  while  others  never 
have  it  except  as  the  result  of  a  fall  or  a  blow.     Among 


3/2  THE    CARE    OF  THE  BABY. 

the  causes,  in  addition  to  idiosyncrasy,  are  disturbances 
of  the  stomach,  irritation  of  the  nose  by  cold  or  by  other 
causes,  malaria,  typhoid  fever,  and  disease  of  the  blood, 
heart,  or  liver.  The  flow  of  blood  may  become  quite 
weakening,  but  is  usually  only  slight.  The  child  should 
be  put  at  rest  with  the  head  elevated  and  held  a  little 
back.  Firm  pressure  should  be  made  on  the  upper  lip 
at  the  outer  edge  of  each  nostril,  and  at  the  root  of  the 
nose  just  at  the  inner  angle  of  each  eye.  This  obstructs 
the  flow  of  blood  by  compressing  the  arteries.  If  this 
does  not  answer,  a  piece  of  ice  may  be  held  on  the  fore- 
head just  above  the  nose,  and  another  at  the  back  of  the 
neck  ;  or,  if  this  fails,  the  nose  can  be  syringed  with  a  solu- 
tion of  tannin  in  water  (Appendix,  87),  and  the  child  given 
a  mustard  foot-bath.  Both  while  the  blood  is  still  flowing 
and  afterward,  blowing  of  the  nose  must  not  be  allowed. 
In  very  bad  cases  a  physician  may  need  to  plug  the 
nostrils  with  pieces  of  cotton  attached  to  strings,  but  this 
is  seldom  required.  In  cases,  too,  in  which  nose-bleed 
frequently  recurs  medical  advice  ought  to  be  had. 

Poison-ivy  Rash, — An  intense  inflammation  of  the 
skin  may  be  produced  by  the  leaves  of  several  species  of 
sumach.  The  one  most  commonly  met  with  is  the 
poison  ivy  {Rhus  toxicodendron)^  a  vine  with  dark-green, 
very  shining  leaves  arranged  in  clusters  of  ihree  and  with 
the  edges  smooth  or  only  slightly  and  irregularly  toothed 
(Fig.  81).  It  is  found  in  abundance  climbing  over  fences 
and  trees  in  many  localities.  When  it  has  nothing  to 
climb  on  it  forms  a  low,  bushy  growth  two  or  three  feet 
high,  and  is  then  called  the  poison  oak.  Nurses  should 
be  able  to  recognize  the  plant,  in  order  that  they  may 
keep  their  charges  away  from  it.  The  only  common 
plant  that  at  all  resembles  it  is  the  Virginia  creeper, 


THE   SICK  BABY. 


373 


which,  however,  has  its  leaves  in  clusters  oi  five  (Fig. 
82).  Some  children  can  handle  poison  ivy  with  impu- 
nity, while  others  become  badly  poisoned  by  the  slightest 


Fig.  81.— Leaf  of  the  poison  ivy.  Fig.  82. — Leaf  of  the  Virginia  creeper. 

touch  or  even  by  close  proximity  to  it.  The  swamp  dog- 
wood or  poison  elder  {Rhus  venenata)  is  another  species 
of  sumach  even  more  virulent  than  the  poison  ivy.  It  is 
a  shrub  ten  to  eighteen  feet  high,  with  leaves  in  clusters 
of  from  seven  to  thirteen.  Its  situation  in  swamps  makes 
it  less  dangerous  to  children.  On  the  Pacific  coast  is 
still  another  poisonous  species  of  sumach  {Rhus  diversi- 
loba)^  which  also  goes  by  the  name  of  poison  oak. 

The  rash  of  poison  ivy  usually  comes  out  in  abundance 
within  a  few  hours  or  a  day  after  exposure.  In  this  re- 
spect it  differs  from  eczema,  which  is  slower  in  its  onset. 
The  skin  becomes  swollen,  red,  hot,  and  itching,  and  is 
thickly  covered  with  vesicles  of  from  pin-head  to  split-pea 
size.  These  soon  discharge  their  watery  contents,  which 
dry  into  crusts  over  the  surface.  The  face  often  becomes 
so  swollen  that  the  child  can  scarcely  open  its  eyes  and 
is  really  a  pitiable  object.     The  disease  lasts  a  week  or 


374  ^-^^    CARE    OF  THE   BABY. 

longer,  except  in  the  very  mildest  cases.  A  useful  appli- 
cation is  a  diluted  preparation  of  Grindelia  robusta  {}4 
draclini  of  the  fluid  extract  in  8  ounces  of  water).  Thin 
cloths  wet  with  this  should  be  applied,  allowed  to  dry, 
removed,  re-wet,  and  reapplied.  Sometimes  an  oily 
dressing  will  act  more  serviceably  upon  the  heat  and 
tenseness,  as  it  is  without  the  discomfort  which  attends 
the  drying  of  a  watery  application.  Thus,  carbolized  oil 
(Appendix,  76)  diluted  with  an  equal  quantity  of  sweet 
oil  may  be  smeared  on  the  skin  frequently,  if  the  in- 
flamed area  is  not  too  extensive  (see  remarks  in  Appendix, 
81).  A  very  useful  plan  of  treatment  consists  in  dabbing 
the  affected  parts  with  "black  wash"  (to  be  purchased 
from  the  druggist),  and,  before  they  are  quite  dry,  smear- 
ing them  with  oxide-of-zinc  ointment.  This  may  be 
done  several  times  a  day.  In  this  connection  may  be 
mentioned  the  fact  that  various  drugs  are,  in  some  per- 
sons, capable  of  producing  eruptions  upon  the  skin. 

Fainting. — This  consists  of  loss  of  consciousness,  with 
pallor,  due  to  a  sudden  temporary  weakness  of  the  heart. 
It  is  more  apt  to  develop  in  later  childhood  than  earlier. 
The  child  should  be  placed  with  the  head  low;  some- 
times lower  than  the  rest  of  the  body,  and  have  the  face 
slapped  with  a  wet  towel  or  water  dashed  into  it.  Access 
to  fresh  air  should  also  be  obtained. 

Drowning. — Drowning,  or  suffocation  from  any  other 
cause,  is  an  accident  for  which  every  mother  ought  to  be 
prepared,  as  there  is  rarely  time  to  send  for  medical  aid. 
An  effort  should  be  made  at  resuscitation,  even  though 
there  seem  to  be  not  the  slightest  chance  of  doing  any 
good.  As  soon  as  the  child  is  taken  out  of  the  water  it 
should  have  the  clothes  loosened  about  the  neck  and  be 


THE   SICK  BABY.  375 

suspended  or  turned  upon  the  face  for  a  second  or  so,  to 
allow  the  water  to  run  out  of  the  mouth.  It  should  then 
be  laid  on  the  back  with  the  shoulders  slightly  raised  by 
a  folded  coat  placed  under  them,  but  with  the  head 
touching  the  ground.  The  tongue  should  now  have  a 
handkerchief  or  cloth  wrapped  around  it  and  be  drawn 
well  out  of  the  mouth  and  held  thus.  Artificial  respira- 
tion must  now  be  commenced  on  the  spot.,  following  what 


Fig.  83.— Resuscitation  after  drowning :   first  movement. 

is  known  as  ^'Sylvester's  method."  Someone  kneels 
behind  the  unconscious  child,  seizes  the  arms,  and 
swings  them  around  horizontally  close  to  the  ground 
until  they  meet  above  the  head  (Fig.  83).  They  are  kept 
there  for  a  moment,  pulling  upon  them  strongly  the 
while.  The  whole  manoeuvre  lasts  two  or  three  seconds, 
and  is  intended  to  expand  the  chest  and  to  make  air 
enter  it.  The  arms  are  then  placed  beside  the  chest  and 
given  a  forcible  push  against  the  lower  ribs  (Fig.  84). 
This  second  manoeuvre  lasts  only  about  a  second.  Its 
object  is  to  expel  the  air  from  the  lungs.  There  should 
be  sixteen  or  eighteen  of  the  artificial  inspirations,  and  of 
course  an  equal  number  of  expirations,  made  in  one  min- 
ute. The  movements  should  be  kept  up  for  a  long  time 
— even  as  long  as  a  couple  of  hours — until  it  is  absolutely 
certain  that  the  heart,  not  the  pulse,  has  ceased  beating. 


376 


THE   CARE    OF  THE  BABY. 


While  artificial  respiration  is  being  conducted,  someone 
should  quickly  remove  the  wet  clothing,  dry  the  body, 
and  apply  warmth  in  any  form — as  hot  water,  hot  bottles, 
stones  heated  in  fires  which  may  be  built  close  by,  hot 
sand  if  at  the  sea-shore,  etc.  The  limbs  should  be 
rubbed  in  the  direction  from  the  extremities  toward  the 
heart,  in  order  to  favor  the  circulation  of  blood.     When 


Fig.  84.— Resuscitation  after  drowning:  second  movement. 

breathing  begins  the  artificial  respiration  must  be  made 
to  keep  time  with  it  as  much  as  possible,  so  as  to  help 
and  not  to  hinder  it.  The  inhalation  of  smelling-salts 
and  the  shock  produced  by  slapping  the  face  with  a  wet 
cloth  aid  in  inciting  respiration.  The  child  should  be 
given  stimulants  in  moderate  amounts  as  soon  as  it  can 
swallow.  It  ought  not  to  be  moved  from  the  spot,  un- 
less the  coldness  of  the  weather  necessitates  it,  until  it 
is  thoroughly  convalescent. 

Swallowing  of  Poisons. — Scarcely  anything  in  the 
realm  of  household  medicine  can  be  more  important  than 
the  treatment  of  poisoning  in  its  various  forms,  since  in 
this,  of  all  things,  knowledge,  presence  of  mind,  and 
promptness  are  of  so  much  avail.  Prevention  is  far  bet- 
ter than  cure,  and  can  usually  be  accomplished  by  allow- 


THE   SICK  BABY.  377 

ing  nothing  of  a  dangerous  nature  to  be  about.  The 
precautions  in  the  care  of  medicines  detailed  in  Chapter 
X.,  pp.  228,  232,  should  be  carefully  followed,  and  the 
baby  be  kept  from  access  to  the  match-box  or  to  toys 
colored  with  poisonous  pigments. 

The  symptoms  of  the  various  forms  of  poisoning  con- 
stitute too  complicated  a  subject  to  discuss  here.  All  the 
mother  needs  to  know  is  what  to  do  in  case  she  suspects 
that  poison  has  been  taken.  Of  course  some  one  will  be 
sent  for  a  doctor  at  once,  with  a  message  telling  him  what 
has  happened^  and^  if  possible^  what  poison  has  been  swal- 
lowed. These  details  are  most  important  in  order  that 
he  may  come  prepared.  At  the  same  time  the  mother 
will  begin  treatment  immxcdiately.  When  the  nature  of 
the  poison  is  unknown,  the  first  thing  to  do  is  to  empty 
the  stomach  by  an  emetic  (Appendix,  in),  or  to  encour- 
age vomiting  in  the  same  way  if  it  is  already  going  on. 
Next,  some  antidote  must  be  given  which  is  capable  of 
neutralizing  a  good  many  different  sorts  of  poisons. 
Such  an  one  is  that  known  as  JeaiinePs  general  antidote 
(Appendix,  no),  which  neutralizes  acids,  arsenic,  digi- 
talis, and  zinc,  and  to  some  extent  copper,  morphine, 
and  strychnine.  It  is  of  no  value  against  phosphorus,  and 
of  but  little  against  corrosive  sublimate.  After  the  anti- 
dote, which  must  be  given  freely,  "soothing  drinks  "  of 
various  kinds  should  be  administered,  such  as  milk,  raw 
white  of  eggs  alone  or  dissolved  in  water,  solutions  of 
gum  arable,  flour  and  water,  flaxseed  tea,  barley-water, 
slippery-elm-water,  etc. 

The  following  table  shows  in  convenient  form  some  of 
the  principal  poisons  and  their  antidotes.  The  antidote 
italicized  is  the  direct  antagonist  of  the  poison.  In  ad- 
dition, it  may  be  stated  that  stimulants  and  external  heat 
are  needed  in  all  cases  of  poisoning,  of  whatever  sort,  if 


378 


THE    CARE    OF   THE  BABY. 


the  child  grows  cold  and  weak,  and  complete  rest  in  bed 
in  all  except  narcotic  poisoning,  as  by  opium  and  chloral. 
Artificial  respiration  may  be  tried  whenever  respiration 
seems  disposed  to  cease.  It  is  carried  out  in  the  same 
way  as  for  cases  of  drowning. 


TabIvi;  of  Poisons  and  Antidotes. 


Poison. 


Unknown 


Acid,  acetic,  hydrochloric, 
sulphuric,  nitric. 

Acid,  carbolic  ;  creosote  . 


Acid,     oxalic,     including 
"salts  of  lemon." 


Acid,  prussic 


Aconite 

Alcohol  (brandy,  etc.)    .    . 

Alkalies  (as  ammonia,  spir- 
its of  hartshorn,  lye,  caus- 
tic potash). 

Antimony  (tartar  emetic)  . 


Arsenic  (Fowler's  solution, 
Paris  green,  "  Rough  on 
Rats"). 


Emetic,  followed  by  Jeaunel's  anti- 
dote and  soothing  drinks. 

An  alkali,  such  as  magnesia,  chalk, 
whiting,  soda,  soap  ;  followed  by 
soothing  drinks  or  sweet  oil. 

Epsom  salt  in  abundance  ;  soap  ;  no 
oil. 

Emetic,  followed  by  lime  (as  chalk, 
plaster,  whiting)  or  ?nagnesia,  but 
not  by  potash  or  soda  ;  then  sooth- 
ing drinks. 

Fresh  air ;  ammonia  to  nostrils  ;  cold 
douche  ;  artificial  respiration. 

Emetic,  followed  by  digitalis;  no 
pillow  under  head  ;  free  stimula- 
tion. 

Emetic ;  cold  douche  on  head ; 
warmth  and  artificial  respiration. 

Vinegar  or  lemon-juice,  followed  by 
soothing  drinks  or  sweet  oil. 

Emetic  if  vomiting  is  not  already 
profuse  ;  then  tannic  acid  freely, 
or  strong  tea  ;  later,  milk  or  other 
soothing  drinks ;  finally,  castor 
oil  to  empty  the  bowels. 

Emetic,  quickly  followed  hy  plenty  of 
a  fresh  mixture  of  the  tinctiire  of 
chloride  of  iron  with  calcined  mag- 
7iesia,  washing  or  baking  soda,  or 
water  of  ammonia,  or  by  feauiieV s 
antidote..  Then  white  of  egg,  sooth- 
ing drinks,  or  sweet  oil ;  castor 
oil  to  empty  bowels. 


THE  SICK  BABY. 


379 


Atropine  (see  Belladonna). 
Belladonna  (atropine)    .   . 


Kmetic  ;  tannic  acid  freely ;  cold  to 
head ;  coffee.  Stimulants  and 
warmth  if  needed. 


Chloroform,  inhaled 


Copper  (blue  stone ; 
vitriol ;  verdigris). 


Corrosive  sublimate 


blue 


Blue  stone;  blue  vitriol  (see  Copper). 

Chloral Treatment  as  for  opium-poisoning. 

Cold  douche  ;  friction  of  skin  ;  in- 
verting child;  artificial  respira- 
tion. 
Emetic,  followed  by  white  of  egg  or 
milk,  yellow  prussiate  of  potash  ; 
then  soothing  drinks. 
'  Emetic,  followed  by  white  of  egg  or 
milk  ;  soothing  drinks  ;  tannic 
acid  freely ;  castor  oil  to  open 
bowels. 

Cyanide  of  potash  (see  Acid,  prussic). 
Fowler's  solution  (see  Arsenic). 

Gas(illuminatinggas, coal-  J  Fresh    air;    artificial    respiration; 

ammonia  to  nostrils ;  cold  douche. 
Starch  or  flour  mixed  with  water, 
given  freely  ;    emetic  ;    soothing 
drinks. 


gas). 
Iodine 


Laudanum  (see  Opium) . 
Lead  (sugar  of  lead)   .   . 

Matches  (see  Phosphortis). 
Morphine  (see  Opium). 
Nux  vomica  (see  Strychnine) 


Opium  (including  lauda- 
num, morphine,  pare- 
goric, soothing  syrups, 
etc.). 


Paregoric  (see  Opium). 
Paris  green  (see  Arsenic). 


Emetic,  followed  by  Epsom    salt; 
white  of  egg  or  milk  ;  alum. 


Emetic  (but  generally  useless)  ;  per- 
majiganate  of  potash  in  doses  of  4 
or  5  grains  if  case  is  seen  early  ; 
strong  coffee  ;  atropine  ;  keep  child 
awake  and  breathing  by  cold 
douche  to  head  and  spine,  walk- 
ing, etc.,  but  not  to  extent  of  ex- 
haustion ;  artificial  respiration. 


38o 


THE    CARE    OF  THE   BABY. 


Phosphorus  (match-heads, 
some  roach  and  rat  poi- 
sons). 

Poisonous  plants  (Jimson 
weed,  poisonous  mush- 
rooms, deadly  night- 
shade, tobacco,  etc.). 

Prussic  acid  (see  Acid,  prnssic). 


Emetic  ;  then  permanganate  of  pot- 
ash in  doses  of  4  or  5  grains  well 
diluted  ;  then  Epsom  salt  or  mag- 

I        nesia  to  open  bowels,  but  no  milk 

I       or  oil  of  any  kind. 

f  Emetic,    followed   by  tannic   acid  ; 

j       strong  coffee  or  bran dy  ;  ammonia 

':       to  nostrils  ;  external  warmth  ;  ar- 

t      tificial  respiration. 


vSilver  nitrate  (lunar  caus- 
tic). 

Spoiled  food 


Strychnine  (nux  vomica) 
Tartar  emetic  (see  Antimo7iy). 


Table-salt,  followed  by  emetic  ;  milk 
or  white  of  eggs. 

Emetic,  followed  by  castor  oil  as 
purgative. 

Emetic,  followed  by  tannic  acid, 
bromide  of  potash  freely,  or  chlo- 
ral. 


APPENDIX. 


In  this  Appendix  are  grouped,  for  the  sake  of  con- 
venience, a  somewhat  heterogeneous  collection  of  sub- 
jects, which  may  be  classified  under— I.  Dietary;  11. 
Remedies  for  Local  Use;  III.  Remedies  for  Internal 
Administration;  and  IV.  Miscellaneous.  The  various 
minor  divisions  are  numbered,  and  the  references '  scat- 
tered here  and  there  in  the  preceding  chapters  refer  to 
these. 

.     I.    DIETARY. 

Under  this  heading  we  may  consider  some  of  the 
special  foods  for  babies  and  older  children,  particularly 
those  intended  for  use  in  sickness.  The  preparation  of 
ordinary  articles,  such  as  jellies,  broths,  soups,  and  the 
like,  may  be  found  described  in  any  good  cook-book,  and 
is  too  extensive  a  subject  to  be  touched  on  here. 

I.  Barley-Water.  —  Put  i  rounded  tablespoonful  of 
whole  barley  into  an  enamelled  saucepan  ;  boil  for  not 
more  than  five  minutes  and  throw  the  water  away.  Then 
add  I  quart  of  water;  allow  to  simmer  slowly  down  to  i 
pint;  strain. 

Often  ordered  as  a  diluent  for,  or  as  a  temporary  sub- 
stitute for,  milk  in  cases  of  vomiting  of  infants. 

In  place  of  whole  barley  a  barley  flour  may  be  used, 
when  economy  of  time  is  desired,  as  follows: 

Rub  up  I  rounded  dessertspoonful  of  barley  flour  with 
a  little  cold  water,  stir  into  i  pint  of  barley  water,  sim- 
mer for  fifteen  minutes  with  stirring;  strain. 

381 


382  THE    CARE    OF   THE  BABY. 

2.  Barley  Jelly. — A  stronger  solution  of  barley,  which 
will  jelly  when  cold,  is  made  by  using  4  level  table- 
spoonfuls  of  whole  barley  or  2  rounded  tablespoonfuls  of 
barley  flour  with  the  amounts  of  water  specified,  and  fol- 
lowing the  methods  described  in  the  previous  section.  A 
double  boiler  may  be  used  with  advantage  to  prevent 
burning. 

3.  Albumen-Water. — The  raw  white  of  one  or  two 
eggs  dissolved  slowly  in  a  glass  of  cold  water.  Sweet- 
ened if  desired,  and  strained  only  if  necessary  to  prevent 
clogging  of  the  rubber  nipple  by  minute  shreds.  It  may 
be  warmed  only  slightly  before  given.  It  is  useful  as  a 
temporary  nourishment  when  milk  does  not  agree. 

4.  Barley  and  Egg. — A  combination  of  Nos.  2  and  3 
may  be  made  as  follows : 

Barley-water,  10  ounces; 

White  of  ^%%.,  I ; 

White  sugar,  i  to  2  teaspoonfuls. 

5.  Oatmeal -Water. — Stir  i  tablespoonful  of  Bethlehem 
oatmeal  into  i  pint  of  boiling  water;  cover  and  let  sim- 
mer for  an  hour.  Replace  the  water  as  it  evaporates. 
Strain. 

Often  prescribed  in  place  of  plain  water  for  diluting 
milk  when  constipation  exists, 

6.  Oatmeal  Jelly. — For  making  a  jelly  at  least  2 
rounded  tablespoonfuls  are  required.  This  should  be 
added  to  i  pint  of  water  and  cooked  as  in  preparing  oat- 
meal-water. A  double  boiler  is  of  service  to  prevent 
burning. 


DIETARY.  383 

7.  Arrowroot- Water. — Wet  2  rounded  teaspoonfuls  of 
arrowroot  with  a  little  cold  water  and  rub  until  smooth; 
then  stir  into  i  pint  of  boiling  water  and  boil  for  five 
minutes,  stirring  all  the  while. 

Often  added  to  milk  mixtures  to  prevent  the  tendency 
to  form  hard  curds. 

8.  Arrowroot  Jelly. — Rub  2  rounded  tablespoonfuls  of 
arrowroot  with  a  little  cold  water,  add  to  i  pint  of  water, 
and  boil  for  five  minutes  with  constant  stirring,  or  in  a 
double  boiler. 

9.  Toast-Water. — On  two  or  three  slices  of  bread, 
toasted  dark  brown,  but  not  burned,  pour  i  quart  of  boil- 
ing water;  allow  to  stand  until  cool;  strain. 

•    Useful  in  some  cases  of  sick  stomach. 

10.  Rice-Water. — 

Rice  (well  washed),  i  ounce  (i  heaping  tablespoonful) ; 
Warm  water,  i  quart. 

IvCt  stand  an  hour  in  a  warm  place  ;  then  boil  slowly  to 
I  pint;  strain. 

Sometimes  useful  for  diluting  milk  in  cases  of  diar- 
rhoea. 

11.  Gum-Arabic  Water. — 

Gum  Arabic,     i  ounce  (i  heaping  tablespoonful); 

Boiling  water,   i  pint. 
Dissolve;  sweeten.     Add  the  juice  of  a  lemon  for  older 
children. 

Sometimes  useful  for  infants  in  place  of  barley-water. 

12.  Flaxseed  Tea. — 

Flaxseed  (whole),  i  ounce  (i  rounded  tablespoonful); 
Boiling  water,        i  pint. 


384  THE    CARE    OF   THE   BABY. 

Let  stand  and  keep  warm  for  an  hour  ;  strain  ;  sweeten. 
Add  the  juice  of  a  lemon  for  older  children. 

13.  Gelatin  Solution. — A  piece  of  plate  gelatin,  two 
or  three  inches  square,  is  soaked  for  a  short  time  in  cold 
water  and  then  dissolved  with  stirring  in  ^  pint  of  boil- 
ing water. 

Sometimes  used  in  place  of  barley-water. 

14.  Dr.  J.  F.  Meigs'  Gelatin  Food.  —  Gelatin-water 
is  prepared  as  in  the  last  formula.  As  soon  as  the  gela- 
tin is  dissolved,  and  while  the  water  is  still  boiling, 
add  I  teaspoonful  of  arrowroot  which  has  been  previously 
rubbed  up  into  a  paste  with  a  little  cold  water.  Milk 
and  cream  are  added  at  the  same  time  in  varying  pro- 
portions. 

The  late  Dr.  J.  F.  Meigs  found  this  to  agree  with  many 
sick  children  when  other  foods  failed. 

15.  Whey. — To  i  pint  of  warm  milk  of  about  100°  F., 
not  previously  boiled  or  sterilized,  add  2  teaspoonfuls  of 
essence  of  pepsin  or  liquid  pepsin,  or  2  teaspoonfuls  of 
liquid  rennet,  or  J  a  rennet  tablet  dissolved  in  i  table- 
spoonful  of  lukewarm  water.  After  it  stiffens,  beat  up 
the  curd  with  a  fork.  Strain  off  the  whey  through  a 
thin  flannel  cloth.  If  it  is  to  be  added  to  cream,  first  boil 
the  whey  a  moment  to  stop  further  action  of  the  rennet 
or  pepsin.  A  pint  of  milk  will  make  from  8  to  12  ounces 
of  whey.  As  the  different  rennet  preparations  vary  in 
strength,  follow  the  directions  coming  with  them  as  to 
the  amount  to  be  used. 

Useful  for  delicate  stomachs  which  cannot  bear  milk. 

16.  Whey-and-Egg  Mixture. — In  8  ounces  of  whey 


DIETARY.  385 

prepared  as  described  stir  the  white  of  an  egg.  Strain  if 
necessary.  This  is  an  excellent  temporary  diet  in  cases 
of  disturbed  digestion  or  in  fever. 

17.  Cream-and-Whey  Mixture.— 

Cream,  i  ounce; 

Whey,  5  ounces; 

Milk-sugar,  i  teaspoonful. 

The  whey-and-egg  mixture  just  described  may  be  sub- 
stituted for  whey  if  it  is  desired  to  make  the  preparation 
still  more  nourishing.  The  amount  of  cream  in  the 
formula  will  vary  greatly  with  the  needs  of  the  child.  It 
can  best  be  determined  by  the  physician. 

18.  Wine  Whey. — While  boiling  \  pint  of  milk  add 
2  ounces  of  sherry  wine.     Strain. 

19.  Veal  Tea. — Cut  fine  i  pound  of  veal  as  free  from 
fat  as  possible;  put  into  i>^  pints  of  cold  water;  keep  hot 
without  boiling  for  three  or  four  hours;  strain;  let  cool; 
skim  off  the  fat. 

Sometimes  ordered  in  cases  of  weak  digestion  in  in- 
fants. 

20.  Flour-Ball.— Tie  i  pound  of  flour  tightly  in  a  bag 
and  boil  for  ten  hours.  After  it  is  cold  take  it  out  of  the 
cloth  and  dry  it  for  ten  hours.  Then  peel  off  the  outside 
coat  of  dough.  The  hard  ball  which  remains  should  be 
grated  when  needed  and  mixed  with  milk  in  varying  pro- 
portions: I  or  2  teaspoonfuls  to  8  ounces  of  diluted  milk 
is  generally  sufficient. 

Useful  in  some  cases  of  delicate  stomach. 

25 


386  THE    CARE    OF  THE   BABY. 

21.  Beef  Tea. — To  i  pound  of  lean  beef,  minced  and 
free  from  fat,  skin,  and  tendon,  add  i  pint  of  cold  water. 
Stir  and  let  stand  in  an  earthen  vessel  for  an  hour;  then 
heat  well,  but  without  boiling,  for  another  hour;  strain 
and  let  cool.  When  about  to  use,  remove  all  the  fat  with 
a  piece  of  soft  paper,  warm,  and  season  with  salt. 

22.  Beef  Tea  Rapidly  Made.  —  Place  i  pound  of 
scraped  lean  beef  in  ^  pint  of  boiling  water  in  an 
enamelled  saucepan;  cover;  keep  gently  warm  for  ten 
minutes;  strain  into  a  teacup,  and  place  the  cup  in  ice- 
water.  When  cold,  skim  off  all  fat,  pour  into  a  warmed 
cup,  warm  gently,  season,  and  use. 

Beef  teas  made  by  this  and  the  preceding  recipe  are 
more  palatable  than  some  of  the  ready-made  beef-extract 
preparations,  but  have  little  nutritive  value  as  compared 
with  the  peptonized  beef  foods  on  the  market. 

23.  Scraped  Raw  Meat. — Take  a  thick  piece  of  raw 
tenderloin  or  round  steak  as  free  from  tendon  and  fat  as 
possible,  scrape,  grate,  or  mince  it  very  fine,  and  then  pound 
it  in  a  mortar  until  it  is  reduced  to  a  pulp.  Now  rub  it 
through  a  fine  sieve;  flavor  with  salt  or  occasionally  with 
sugar.  For  younger  children  rub  it  up  with  a  little  water 
until  it  is  of  the  consistence  of  thick  cream,  and  feed  it 
from  a  spoon. 

This  is  very  nourishing  in  some  of  the  wasting  dis- 
eases. A  child  of  a  year  or  less  should  begin  with  not 
more  than  two  teaspoonfuls  during  the  course  of  a  day. 
There  is  the  possibility  of  tape-worm  being  acquired  by 
the  use  of  raw  meat.  To  prevent  this  the  steak  may  be 
cooked  slightly  first  and  then  the  brown  outside  layer 
cut  away. 


DIETARY. 


387 


24.   Beef-Juice. — Cut  into  rather  thin  pieces  and  very 
slightly  broil  i  pound  of  round  or  tenderloin  steak  free 
from  fat.     Then  cut  into  smaller 
pieces  and  express  the  juice  with 
a  lemon-squeezer  or,  much  better, 
with  one  of  the  meat-presses  to 
be     bought     at    the    druggist's 
(Fig.  85).    Season  with  salt.    The 
pound  of  meat  will  give  from  3 
to  6  ounces  of  beef-juice  or  there- 
abouts.  The  juice  can  be  warmed 
only  slightly  after  it  is  obtained, 
or  it  will  coagulate.     It  may  be 
given  cold  if  desired.     Occasion- 
ally infants  prefer  it  sweetened.  fig.  85 .-Meat-press. 


25.  Beef-Juice,  No.  2.— Another  method  recom- 
mended, when  a  lemon-squeezer  or  a  press  is  not  at  hand, 
is  the  following: 

Broil  I  pound  of  beef  as  before,  then  chop  very  fine, 
place  in  a  jar,  add  4  ounces  of  water,  stir  thoroughly, 
stand  on  ice  for  six  or  more  hours.  Strain  through 
cheesecloth  or  muslin  by  twisting  this  hard.  This  method 
gives  probably  twice  as  m.uch  juice  as  the  first. 

26.  Li  me- Water.— Place  a  piece  of  unslaked  lime  the 
size  of  an  ^^g  in  i  gallon  of  water  in  an  earthen  vessel. 
Stir  and  let  settle;  pour  off  the  first  water  and  add  fresh. 
Keep  covered  to  exclude  the  dust.  Use  from  the  top. 
Add  water  and  stir  from  time  to  time. 


27.  Peptonized  Food.— The  failure  of  the  power  of 
digestion  renders  predigestion  (peptonizing)  of  the  food 
necessary  in  some  cases.      Pepsin,   the  secretion  of  the 


388  rilE    CARE    OF   JJ/E    BAIiV. 

stomach,  iiia\-  be  utilized  for  this  purpose,  but  for  several 
reasons  the  secretion  of  the  pancreas,  often  combined  with 
bicarbonate  of  soda,  is  g-enerally  employed.  Although 
there  are  various  equally  good  pancreatic  preparations  on 
the  market,  such,  for  instance,  as  those  of  Parke,  Davis 
&  Co.,  and  x-Vrmour  &  Co.,  yet  for  .sake  of  convenience, 
and  because  it  is  very  well  known,  the  pancreatic  extract 
of  Fairchild  Bros,  and  Foster  is  the  one  mentioned  in 
the  following  recipes.  Besides  being  sold  in  bulk,  it 
is  conveniently  furnished  in  the  form  of  "peptonizing 
tubes,"  each  glass  tube  containing  5  grains  of  extract  of 
pancreas  and  15  grains  of  bicarbonate  of  soda,  and  being 
sufficient  to  peptonize  i  pint  of  milk.  As  the  tubes  are 
rather  expensive,  one  can  just  as  readily  have  a  small 
number  of  powders  put  up  at  a  drug-store,  each  contain- 
ing the  proper  amount  of  pancreatic  extract  and  soda. 
These  absorb  moisture  readily,  and  will  not  keep  good 
very  long  in  this  form;  consequently  they  must  be  used 
promptly. 

In  the  peptonizing  of  any  food  it  is  important  to  re- 
member that  warmth  is  necessary  for  the  action  of  the 
digestant,  while  cold  checks  it,  and  too  great  a  heat  de- 
stroys it  altogether.  The  food  undergoing  peptonizing 
should  be  kept  at  a  temperature  of  about  115°  F. — that 
is,  never  so  hot  that  the  finger  cannot  be  kept  in  it  with- 
out discomfort.  The  peptonizing  must  not  be  allowed 
to  become  quite  complete,  or  the  bitter  taste  of  peptones 
will  be  produced.  This  does  not  injure  the  food  in  the 
least,  but  may  make  the  child  unwilling  to  take  it.  The 
food  should  be  tasted  frequentl\'  during  the  process,  and 
on  the  development  of  the  slightest  bitterness  the  tem- 
perature should  be  quickly  raised  to  the  boiling-point  or 
the  food  be  put  quickly  on  ice.  The  temperature  of 
boiling  is  sufficient  to  destroy  the  digestant  to  a  large 


DIETARY.  3«9 

extent,  and  consequently  to  interfere  with  further  pepton- 
izing. The  chilling  by  ice  arrests  the  action  of  the  pan- 
creatin,  but  only  while  the  milk  is  kept  cold.  On  the 
whole,  boiling  is  to  be  preferred  as  more  manageable. 

28.  Peptonized  Milk. — Add  to  4  taljlespoonfuls  of  cool 
water  the  contents  of  a  peptonizing  tube;  stir  until  dis- 
solved; add  to  I  pint  of  cool  milk,  and  put  the  ves.sel 
containing  this  into  water  of  a  temperature  of  115°  F.; 
let  it  remain  there  for  ten  minutes,  or  for  a  shorter  time 
if  the  slightest  bitter  taste  develops.  Then  put  at  once 
on  ice  or,  better,  heat  quickly  to  boiling. 

29.  Sterilized  Peptonized  IVIilk-Mixture. — Prepare 
the  infant's  milk-mixture  according  to  the  formula 
ordered  bv  the  baby's  physician.  Then  add  the  pepton- 
izing powder  in  the  proportion  of  one  tube  to  each  16 
ounces  of  combined  milk  and  cream.  For  instance,  if 
the  formula  on  page  135  should  be  prescribed,  and  16  per 
cent,  cream  used,  we  have  in  8  ounces  3  ounces  of  milk 
and  cream.  This  will  require  fV  or  about  one-fifth  of 
the  contents  of  a  peptonizing  tube  for  each  8  ounces  of 
mixture.  If  20  per  cent,  cream  is  used,  about  one-sixth 
of  a  tube  is  required,  or  if  the  top  milk-mixture  of  page 
137  is  employed,  then  one-eighth  of  a  tube.  After  add- 
ing the  amount  of  powder  required  for  the  day  to  a  small 
quantity  of  the  water  to  be  used,  shake  thoroughly,  add 
to  the  rest  of  the  milk-mixture,  and  peptonize  as  just  de- 
scribed, finishing  the  process  by  raising  the  temperature 
quickly  to  that  of  1)oiling.  Now  place  the  iiropcr  amount 
of  the  food  in  each  bottle,  put  the  bottles  in  the  sterilizer, 
and  sterilize  for  half  an  hour.  This  will  be  long  enough, 
on  account  of  the  previous  scaldin.g. 

Instead  of  this  plan,  we  may  mix  the  milk  and  cream, 


390  THE   CARE    OF   THE  BABY. 

add  one  peptonizing  tube  to  each  i6  ounces,  and  pep- 
tonize. Then  rapidly  mix  with  milk-sugar  and  water 
according  to  whatever  formula  may  be  prescribed,  place 
the  proper  amount  in  each  bottle  and  sterilize.  This  must 
be  done  quickly  enough  to  prevent  the  bitter  taste  from 
developing.  No  alkaline  solution  need  be  used  in  making 
the  mixture,  as  there  is  sufficient  soda  in  the  peptonizing 
tubes.  If  the  bitter  taste  develops  in  this  way  in  spite 
of  care,  we  must  first  sterilize  the  milk-mixture  in  each 
bottle  in  the  usual  w^ay,  then,  just  before  using  a  bottle, 
uncork  it  and  add  the  proper  amount  of  peptonizing 
powder  as  described  in  the  next  section  (Appendix,  30). 

30.  Pasteurized  Peptonized  Milk-Mixture. — Since 
the  temperature  employed  in  pasteurizing  is  not  suffi- 
ciently high  to  arrest  the  action  of  the  peptonizing  pow- 
der, the  only  feasible  method  is  to  prepare  the  bottles  of 
pasteurized  milk  as  described  on  page  142,  and  to  keep 
them  until  needed.  Then,  as  each  bottle  is  about  to  be 
used  it  should  have  added  as  much  of  the  contents  of  a 
peptonizing  tube  as  is  necessary  to  digest  the  combined 
amount  of  milk  and  cream  in  it  (see  Appendix,  29),  be 
shaken  thoroughly,  stood  in  water  of  110°  to  115°  F.  for 
five  or  ten  minutes,  cooled  down  slightly  to  the  proper 
temperature  for  feeding,  and  given  to  the  baby  at  once, 
before  the  peptonizing  has  a  chance  to  advance  too  far. 
A  little  trial  will  show  the  length  of  time  required  in 
order  to  stop  the  process  short  of  developing  a  bitter 
taste.  We  must  remember  that  the  action  of  the  pancre- 
atin  continues  in  the  bottle  while  the  infant  is  nursing, 
and  that  the  last  portion  of  the  contents  may  grow  too 
bitter.  The  same  method  may,  of  course,  be  used  when 
the  milk-mixture  is  used  raw;  /.  c,  without  either  steril- 
ization or  pasteurization. 


DIE  TAR  V. 


A  "  Peptogenic  Milk-Powder"  is  manufactured  by  the 
makers  of  the  peptonizing  tubes,  and  has  been  largely 
used.  It  does  not  differ  in  any  way  in  composition  from 
the  powder  in  the  tube  except  that  it  has  a  fixed  amount 
of  milk-sugar  and  mineral  salts,  and  is  intended  to  be 
used  with  only  certain  fixed  proportions  of  milk.  This 
is  a  great  disadvantage,  as  it  does  not  permit  of  altering 
the  proportions  of  the  ingredients  of  the  milk-mixture  to 
suit  the  individual  child.  The  methods  described  are 
greatly  to  be  preferred. 

31.  Peptonized  Beef  Tea.— Mix  8  ounces  of  finely- 
minced  beef,  free  from  fat,  with  i  pint  of  water.  Sim- 
mer from  one  to  two  hours  with  frequent  stirring.  Cool 
down  to  110°  or  115°  F.— that  is,  a  temperature  not  hot 
enough  to  give  discomfort  to  the  finger  held  in  it — and 
empty  into  it  one  peptonizing  tube.  Stir  until  dissolved. 
Keep  at  the  same  temperature  for  an  hour  or  two  with 
occasional  stirring,  avoiding  any  bitter  taste.  Then  boil 
for  a  moment,  strain,  and  season. 

32.  Peptonized  Oysters.— Boil  for  a  few  minutes  in  a 
saucepan  half  a  dozen  large  oysters  with  their  juice  and 
}4  pint  of  water.  Remove  the  oysters,  mince  and  mash 
them  to  a  pulp,  and  put  this  into  a  glass  jar  with  the 
broth.  Add  15  grains  of  bicarbonate  of  soda  and  15 
grains  of  extract  of  pancreas,  and  keep  at  115°  F.  for 
one  and  a  half  hours  or  less,  avoiding  any  decidedly 
bitter  taste.  Then  put  into  a  saucepan,  add  >^  pint  of 
milk,  and  heat  to  boiling.     Season. 

33-  Peptonized  Gruel.— Gruel  may  be  made  in  the 
ordinary  way;  as,  for  example: 


392  THE    CARE    OF   THE   BABY. 

Arrowroot,  fine  oatmeal,  wheat 
flour,  sago,  or  other  farina- 
ceous substance,  i     tablespoonful    or 

more ; 

Cold  water,  i^  pint 

Mix  thoroughly  and  boil  well  for  a  few  minutes  with  con- 
stant stirring  until  quite  thick.  Then  stir  in  i<  pint  of 
cold  milk  and  empty  in  one  peptonizing  tube.  Keep 
warm  (115°  F.)  for  twenty  minutes,  or  less  than  this  if 
the  faintest  trace  of  bitterness  develops.  Then  strain, 
and  quickly  raise  it  to  boiling  to  stop  further  action. 

34.  Peptonized  Milk  Toast. — Milk  toast  in  which 
there  is  plenty  of  milk  may  be  peptonized  by  making  it 
into  a  pulp  and  then  stirring  in  the  contents  of  a  pep- 
tonizing tube,  and  proceeding  in  the  same  way  as  for 
peptonizing  gruel. 

35.  Peptonized  Milk  Punch. — Fill  a  tumbler  one-third 
full  of  crushed  ice.  Put  in  it  as  much  stimulant  as  suits 
the  age  of  the  child  (pp.  417,  420)  ;  fill  up  with  pepton- 
ized milk;  sweeten  according  to  taste,  and  grate  a  little 
nutmeg  over  the  top. 

36.  Nutrient  Enemata. — For  the  giving  of  nutrient 
enemata  one  of  the  syringes  already  figured  and  de- 
scribed can  be  employed  (pp.  258,  259).  As  the  bowel 
has  only  feeble  powers  of  absorption,  it  is  better  to  have 
the  food  already  in  a  predigested  state.  To  ensure  its 
beins  absorbed  and  retained  it  is  better  to  have  the  food 
already  in  a  predigested  state  and  to  give  only  very  small 
amounts  at  one  time:  ^^  to  i  teaspoonful  is  enough  at 
one  year  of  age;    i  teaspoonful  to  i  tablespoonful  from 


REMEDIES  FOR   LOCAL    USE.  393 

one  to  four  years  ;  and  from  i  to  8  tablespoonfuls  up  to 
twelve  years.  Any  of  tlie  reliable  peptonized  meat 
preparations  on  the  market  may  be  employed  in  concen- 
tration much  greater  than  is  directed  for  use  by  the 
mouth.  Such  articles  as  defibrinated  blood  and  other 
blood  preparations,  although  not  predigested,  are  readily 
absorbed  and  are  of  great  value. 

Predigested  nutrient  enemata  may  be  made  at  home 
by  the  use  of  pepsin  or,  especially,  pancreatic  prepara- 
tions. Milk  peptonized  in  the  way  already  described  can 
be  given,  or  the  warmed  milk  may  be  mixed  with  the 
peptonizing  agent  and  injected  at  once. 

2,^.  Peptonized  Beef  Enema. — A  peptonized  beef 
enema  may  be   made  as  follows: 

Add  I  tablespoonful  of  minced  lean  raw  beef  to  4  table- 
spoonfuls  of  water.  Heat  to  boiling.  Rub  through  a 
colander.  When  only  warm,  add  the  contents  of  a  pep- 
tonizing tube  and  inject  at  once. 

38.  Peptonized  Egg  Enema. — This  is  a  useful  nu- 
trient enema  made  by  adding  the  contents  of  a  peptoniz- 
ing tube  to  the  white  of  one  ^gg  previously  dissolved  in 
three  times  its  volume  of  water. 

II.  Remedies  for  Local  Use. 

I.  Baths. 

39.  Baths  in  Sickness. — In  a  medical  sense  a  "  bath  " 
is  the  application  of  water  in  nearly  any  way,  either  to  the 
entire  surface  of  the  body  or  to  part  of  it.  Although 
there  are  many  other  varieties,  we  may  limit  our  con- 
sideration to  the  following: 


394  THE    CARE    OF   THE   BABY. 

[a)  Whole  baths,  including — 

1.  Sponge  bath; 

2.  Tub  bath; 

3.  Shower  bath ; 

4.  Sheet  bath ; 

5.  Vapor  bath ; 

6.  Medicated  bath   (mustard,  starch,  soda,  salt, 

sulphur,  bran,  disinfecting). 
{6)  Partial  baths,  including — 

7.  Footbath; 

8.  Wet  compresses,  including  fomentations. 

From  another  point  of  view  baths  ma\'  be  distinguished 
according  to  the  temperature  of  the  water.  A  convenient 
classification  is  the  following: 

1.  Cold  bath,  temperature  of  40°  to    70°  F. 

2.  Cool     "  "  "    70°    "    80°  " 

3.  Tepid  "  "  "    80°    "    90°  " 

4.  Graduated  bath,   "  "    85°    "    90°  "  reduced. 

5.  Warm  bath,  "         "    90°    "  100°  " 

6.  Hot  "  "         "  100°    "  110°  " 

These  definitions  of  temperature  are  used  in  the  descrip- 
tions wdiich  follow. 

40.  Sponge  Bath  or  Ablution. — This  is  the  simple, 
general  washing  of  the  body  with  wash-rag  or  sponge. 
It  may  be  used  as  a  medicinal  agent  as  well  as  for  clean- 
liness. In  sickness  even  more  than  ordinary  care  is 
needed  to  prevent  taking  cold.  The  sick  child  should 
be  undressed  completely,  unless  too  weak,  and  put 
between  blankets.  The  sponging  must  be  performed 
rapidly  and  under  the  covers,  doing  one  part  at  a  time 
and  drying  it  before  going  to  another.  Follow  the  order: 
hands,  arms,  face  and  head,  neck,  chest  in  front,  back, 
abdomen,  lower  extremities. 


REMEDIES  FOR  LOCAL    USE.  395 

Tlie  child  should  be  rolled  from  one  side  to  the  other 
if  too  weak  to  be  lifted.  The  sponge  or  wash-rag  need 
not  be  wet  enough  to  be  sloppy. 

IVarvi  sponging  is  often  very  serviceable  to  allay  rest- 
lessness. Tepid  sponging  or  cool  sponging  is  an  excellent 
means  of  reducing  fever.  Cold  sponging  is  still  more  so, 
but  must  not  be  given  except  by  a  physician's  order. 
The  sponging  may  last  ten  or  fifteen  minutes  and  be  re- 
peated every  couple  of  hours  or  oftener  as  needed.  The 
addition  of  alcohol  or  bay  rum  adds  to  the  cooling  effect. 
When  the  fever  is  threateningly  high  and  cold  sponging 
is  to  be  used,  the  child  should  not  be  covered  at  all  ;  a 
rubber  sheet  is  placed  beneath  the  blanket,  and  the  sponge 
may  be  large  and  saturated  with  water.  On  account  of 
the  fear  which  some  physicians  have  of  the  use  of  water 
in  eruptive  fevers,  no  sponging  at  all  should  be  used  in 
such  cases  until  the  doctor  has  been  consulted.  Spong- 
ing with  bathing-whiskey  or  with  a  mixture  of  equal 
parts  of  alcohol  and  water  containing  all  the  alum  that 
will  dissolve  in  it  is  useful  where  there  is  much  perspira- 
tion or  when  the  skin  seems  tender  and  liable  to  become 
sore  (Appendix,  88).  Alum  will  not  dissolve  at  all  in 
alcohol  alone. 

Cold  sponging  is  also  an  excellent  tonic  remedy  in 
children  who  are  somewhat  debilitated  or  who  are  prone 
to  take  cold  very  easily.  The  child  receives  its  tub  bath 
in  the  ordinary  manner,  and  then  as  a  last  touch  has 
water  of  a  temperature  of  from  60°  to  70°  squeezed  over 
it  from  a  large  sponge.  A  brisk  rubbing  with  a  Turkish 
towel  follows. 

41.  Tub  Bath. — The  use  of  the  tub  for  washing  has 
already  been  described.  The  zvarin  hib  bath  is  of  service 
in  disease,  but  must  be  given  with  the  greatest  precau- 


396  THE    CARE    OF   THE  BABY. 

tions  against  subsequent  chilling.  It  is  often  ordered  for 
the  purpose  of  bringing  out  and  keeping  out  the  eruption 
of  measles  or  scarlet  fever  in  severe  cases  in  which  the 
gravity  of  the  symptoms  is  associated  with  the  failure  of 
the  rash  to  develop  properly  (see  remarks  on  Fever,  p. 
346).  It  may  well  be  given  at  the  onset  of  any  acute 
febrile  disease.  It  is  also  useful  for  producing  perspira- 
tion and  in  this  way  checking  a  cold,  alla3'ing  nervous 
excitement  and  thus  producing  sleep,  reducing  moderate 
fever,  and  stopping  an  attack  of  convulsions  or  of  spas- 
modic croup.  To  get  the  full  effect  the  child  should  be 
taken  from  the  bath  after  ten  or  more  minutes'  immer- 
sion, placed  quickly  between  warm  blankets  without 
being  dried,  and  covered  well  in  bed.  When  the  bath  is 
used  to  produce  sleep,  the  child  may  be  dried  and  the 
blanket  dispensed  with.  Cases  of  eruptive  fever  should 
not  be  given  warm  baths — except  the  one  given  at  the 
onset — unless  medical  advice  be  first  obtained. 

The  cold  or  cool  hib  bath  intended  for  medical  purposes 
should  be  employed  only  if  the  physician  orders  it.  It 
is  not  often  given  to  young  children  unless  there  is  very 
high  fever  which  cold  sponging  or  tepid  tubbing  fail  to 
reduce.  Many  young  children  with  fever  do  not  bear 
cool  tub  baths  well.  Even  in  later  childhood  they 
are  often  not  well  tolerated.  The  use  of  the  tepid 
bath  is  probably  the  best  method  known  at  the  present 
time  for  treating  typhoid  fever  in  children.  A  modifica- 
tion of  this  consists  in  putting  the  child  in  a  warm,  bath 
and  then  gradually  cooling  the  water  until  the  proper 
temperature  is  reached.  This  is  called  the  graduated 
bath. 

The  hot  tub  bath  is  a  very  powerful  stimulant,  rarely 
to  be  used  without  the  physician's  order.  Sometimes  a 
baby  which  seems  to  be  rapidly  failing  in  strength  or 


REMEDIES  FOR   LOCAL    USE.  397 

growing  cold,  or  becoming  greatly  oppressed  in  breath- 
ing from  some  disease  of  the  lungs,  will  revive  in  a 
wonderful  manner  if  plunged  into  a  bath  of  105°  or  110° 
F.,  kept  there  one  to  two  minutes,  taken  out,  and 
wrapped  in  blankets  without  drying.  Of  course,  gentle- 
ness and  absence  of  sudden  movement  are  absolutelv  es- 
sential in  such  threatening  states.  It  must  also  be  said 
that  the  hot  bath  sometimes  appears  to  make  the  child 
worse.     In  such  a  case  it  must  be  discontinued  at  once. 

42.  Shower  Bath. — The  rc'c/ shower  bath  is  to  be  used 
only  in  later  childhood  as  an  excellent  nervous  and 
muscular  stimulant.  The  cold  shower  bath  should  never 
be  used  unless  a  physician  orders  it. 

43.  Sheet  Bath,  or  Wet  Pack. — This  may  be  either 
hot  or  cold.  To  give  a  cold  pack.^  a  rubber  cloth  should 
be  put  over  the  bed  and  a  sheet  be  wrung  out  in  cold  water 
and  laid  upon  it.  The  child  is  now  stripped,  placed  upon 
and  enveloped  in  the  sheet  with  the  exception  of  the  head, 
and  then  wrapped  outside  of  all  with  a  blanket.  The 
feet  may  be  left  out  if  it  is  desired,  in  order  that  a  hot- 
water  bag  may  be  put  to  them  should  this  seem  advis- 
able. The  cold  pack  is  often  useful  to  quiet  very  great 
nervousness  and  to  produce  sleep.  The  child  may  be 
left  in  it  for  an  hour  or  so  if  it  goes  to  sleep;  or,  if  it 
does  not,  may  be  taken  out  in  fifteen  minutes  and 
wrapped  in  a  warm,  dry  blanket.  The  pack  is  also  em- 
ployed for  reducing  moderate  fever,  but  in  order  to  be  of 
any  service  it  must  be  renewed  every  five  or  ten  minutes 
ten  or  twelve  consecutive  times  if  the  temperature  is 
high;  the  whole  process  lasting  about  an  hour.  Where 
fever  is  extremely  high  a  pack  with  ice-water  is  some- 
times employed.     The  child  is  stripped  and  covered  with 


398  THE    CARE    OF   THE  BABY. 

cloths  dipped  in  the  ice-water,  not  forgetting  to  place 
them  on  the  head.  The  cloths  must  be  redipped  every 
two  or  three  minutes,  and  the  rectal  temperature  must 
be  taken  very  frequently  to  guard  against  too  great  a  fall, 
as  the  remedy  is  a  powerful  one. 

A  hot  pack .^  or  blanket  batli^  is  given  by  wrapping  the 
child  in  blankets  wrung  out  in  hot  water,  and  covering 
with  several  dry  blankets.  The  pack  may  be  renewed  in 
half  an  hour.  It  produces  perspiration  in  the  same  way 
as  the  warm  bath  with  subsequent  blanket  wrappings. 

44.  Vapor  Bath. — This  is  used  to  relieve  the  dropsy 
of  Bright' s  disease  by  producing  free  perspiration.  The 
bed  is  well  covered  with  blankets  which  reach  nearly 
or  quite  to  the  floor,  but  which  are  kept  off  the  child 
by  half  barrel-hoops  or  by  a  chair  in  the  bed  or  in  some 
other  way.  A  stream  of  vapor  from  a  kettle  or  pan  of 
boiling  water  is  conducted  by  a  tin  pipe  beneath  the 
cover,  taking  care  that  it  does  not  come  in  too  hot  a 
state  against  the  body.  Other  methods  of  producing 
vapor  consist  in  placing  a  vessel  of  slaking  lime,  or  a 
bucket  of  water  with  hot  bricks  dropped  into  it,  under 
the  bed  in  such  a  way  that  the  vapor  can  rise  at  the  sides 
and  reach  the  child  under  the  covers. 

45.  Hot-air  Bath. — This  is  used  for  the  same  purpose 
as  the  vapor  bath,  of  which  it  is  a  modification.  The  hot 
air  from  an  alcohol  lamp  is  conducted  under  the  covers 
by  a  tin  pipe,  the  heat  producing  profuse  perspiration. 

With  either  of  these  baths  great  care  must  be  observed 
that  the  bed  clothing  does  not  become  ignited  by  the 
flame  of  the  lamp. 

46.  Mustard   Bath. — Mustard    is  added  to  the  warm 


REMEDIES  FOR   LOCAL    USE.       '  2,99 

tub  bath  in  the  proportion  of  >^  or  i  ounce  (i  to  2  mod- 
erately heaping  tablespoon fuls)  to  i  gallon  of  water. 
This  is  superior  to  the  simple  warm  bath  for  bringing 
out  the  rash  in  eruptive  fevers  (see  p.  321),  and  is  a 
powerful  stimulant  when  the  child  is  rapidly  failing  from 
any  cause.  It  is  especially  useful  in  infancy  and  early 
childhood. 

47.  Starch  Bath  ;  Starch-Water. — The  starch  bath 
should  be  made  of  the  strength  of  >^  a  cupful  of  boiled 
starch  to  every  4  gallons  of  water.  If  the  starch  has 
jellied,  it  may  be  broken  up  with  the  hand  or  pressed 
through  a  coarse  wet  cloth.  The  bath  is  very  useful  for 
hives  and  some  other  irritating  shin  affections. 

A  smaller  quantity  of  starch-water  for  washing  the 
skin  or  for  douching  the  intestine  (page  240)  may  be 
made  by  adding  to  each  pint  of  boiling  water  2  level  tea- 
spoonfuls  of  pulverized  starch,  and  stirring  until  smooth. 
The  starch  should  first  be  rubbed  into  a  paste  with  a 
little  cold  water.  For  giving  small  injections  the  starch- 
water  is  often  made  decidedly  thicker. 

48.  Soda  Bath. — This  consists  of  i  tablespoonful  of 
washing  soda  to  every  4  gallons  of  water.  It  is  used  for 
the  same  purpose  as  the  starch  bath,  with  which  it  is 
very  commonly  combined  by  dissolving  the  soda  in  the 
starch-water. 

49.  Salt  Bath. — This  may  be  made  by  dissolving  ordi- 
nary salt,  rock  salt,  or  prepared  sea-salt  in  water  in  the 
strength  of  4  ounces  (4  heaping  tablespoonfuls)  to  i  gal- 
lon. Given  tepid  or  cool  and  followed  by  brisk  rubbing, 
it  is  a  valuable  toijic,  especially  for  rickety  children. 


400  THE    CARE    OF   THE   BABY. 

50.  Sulphur  Bath. — This  is  made  by  dissolving  20 
grains  of  sulphide  of  potash  in  each  gallon  of  water.  It 
cannot  be  given  in  a  metal  tub.  It  is  considered  of  ser- 
vice in  chronic  rheumatism  and  in  some  affections  of  the 
skin. 

51.  Bran  Bath. — Enough  bran  may  be  put  in  the  hot 
bath  to  make  it  milky.  As  this  would  choke  the  pipes 
of  stationary  bath-tubs,  the  bath  can  be  made  by  putting 
a  pound  or  more  of  bran  into  a  thin  muslin  bag  and  boil- 
ing this  for  a  quarter  of  an  hour,  squeezing  it  now  and 
then.  The  water  may  then  be  added  to  the  bath  until  it 
is  milky.  Bran  baths  are  used  in  certain  diseases  of  the 
skin. 

52.  Disinfecting  Bath. — (See  Appendix,  102). 

53.  Foot-Bath. — A  partial  bath  of  this  sort  is  gener- 
ally given  in  the  form  of  the  hot  mustard  foot-bath,  in 
the  proportion  of  i  ounce  of  mustard  (2  moderately  heap- 
ing tablespoonfuls)  to  i  gallon  of  water.  Fresh  hot  water 
must  be  added  from  time  to  time.  The  foot-bath  is  an 
excellent  measure  when  a  child  has  taken  cold.  Great 
care  must  be  observed,  however,  to  have  the  room  warm, 
the  bed-clothes  also  warm,  and  to  ensure  protection  of 
the  rest  of  the  body,  including  the  thighs,  when  the  feet 
and  legs  are  in  the  water.  A  useful  plan  is  to  have  the 
tub  in  the  bed,  under  the  covers,  while  the  child  lies  in 
bed  well  covered  up,  and  the  bed  is  well  protected  by  oil 
cloth  or  rubber  sheeting  or  by  a  folded  blanket.  The 
bath  should  last  from  fifteen  to  twenty  minutes.  It  is 
often  best  to  put  the  child  between  blankets  afterward, 
as  in  the  case  of  the  warm  tub  bath. 


REMEDIES  FOR   LOCAL    USE.  4OI 

54.  Wet  Compress.— This  form  of  partial  bath  con- 
sists of  a  cloth  wet  with  water  and  kept  applied  to  some 
part  of  the  body.  An  ordinary  zuarm  compress  is  made 
by  folding  a  piece  of  soft  cloth  or  of  patent  lint  into  two 
or  three  thicknesses,  dipping  it  into  tepid  water,  laying 
it  on  the  part,  covering  it  with  a  piece  of  oil  silk  or  par- 
affin paper  a  little  larger  than  the  cloth,  and  gently  band- 
aging it  on.  It  is  useful  in  reducing  inflammation,  as 
in  cases  of  sore  throat. 

A  cold  compress  consists  of  a  thin  cloth,  such  as  a  hand- 
kerchief, folded  into  two  or  three  layers,  dipped  in  cold 
water  or,  perhaps,  in  ice-water,  wrung  out,  and  laid  on 
the  affected  part.  Alcohol  with  twice  its  volume  of  ice- 
water  is  serviceable  for  this  purpose.  The  compress  is 
not  covered  with  oil  silk,  and  it  must  be  changed  every 
few  minutes,  since  it  rapidly  becom.es  warm.  Instead  of 
this  method,  it  may  be  kept  cold  by  allowing  ice-water 
to  drop  on  it  from  a  vessel  higher  than  the  patient.  A 
strip  of  soft  cotton  cloth  or  a  skein  of  darning  cotton  or 
a  lamp-wick,  with  one  end  in  the  vessel  and  the  other  on 
the  compress,  will  supply  enough  fresh  water.  A  rubber 
cloth  should  be  placed  under  the  compress  in  such  a  way 
that  the  child  does  not  become  wet.  The  cold  compress 
is  of  service  in  inflammation,  sprains,  and  the  like. 

A  hot  compress,  or  fomentation,  is  made  of  a  piece  of 
flannel  folded  three  or  four  times  into  the  form  of  a  pad. 
This  is  placed  in  an  open  towel,  dipped  into  boiling 
water,  wrung  out  thoroughly  by  twisting  the  towel,  re- 
moved from  it,  tested  by  the  nurse  against  her  cheek  to 
ascertain  thai  it  is  not  too  hot,  applied  to  the  part,  and 
covered  quickly  with  oil  silk  and  a  folded  dry  towel,  with 
or  without  a  bandage.  The  fomentation  should  be  re- 
newed in  half  an  hour  if  we  wish  to  keep  up  decided 
heat.  It  is  often  very  useful  in  relieving  pain.  A  poul- 
tice is  to  be  preferred,  except  that  it  is  heavier. 


402  the  care  of  the  baby. 

2.  Poultices  and  Plasters. 

55.  Poultices. — The  poultice  is  intended  to  furnish  a 
dressing  which  will  retain  its  heat  longer  than  a  fomen- 
tation. It  should  be  half  an  inch  or  less  in  thickness. 
The  thicker  it  is  the  longer  it  stays  warm,  but  of  course 
the  greater  its  weight.  Placed  on  the  chest,  it  must  be 
thin  or  its  weight  will  do  harm.  A  poultice  should 
always  be  tested  against  the  cheek  of  the  nurse  before  it 
is  applied  to  the  child,  and  should  always  be  put  on 
slowly.  Of  the  various  forms,  those  made  of  flaxseed, 
slippery  elm,  mush,  bread,  bran,  hops,  starch,  mustard, 
and  charcoal  may  be  referred  to. 

56.  Flaxseed  Poultice. — One  of  the  best  known  and 
most  serviceable  kinds.  Heat  a  sufficient  quantity  of 
water  in  a  tin  or  china  dish  nearly  or  quite  to  boiling. 
Add  flaxseed  meal  slowly,  stirring  constantly  and  vigor- 
ously with  a  spoon  until  it  is  of  the  consistence  of  hot 
mush,  too  thick  to  flow.  Spread  this  with  a  case-knife 
upon  a  piece  of  cotton  or  linen  cloth;  fold  the  edges 
over  slightly,  and  cover  it  with  an  old  pocket-handker- 
chief or  piece  of  thin  muslin,  cheese-cloth,  or  netting. 
Test  to  see  that  it  is  not  too  hot;  apply,  cover  with  oil 
silk  or  paraffin  paper,  and  bandage  on.  Renew  every  few 
hours.  The  addition  of  a  little  oil  will  keep  it  soft  longer. 
Everything  must  be  in  readiness  before  the  poultice  is 
mixed,  or  it  will  grow  cold. 

57.  Slippery-Elm  Poultice. — Prepared  from  ground 
slippery-elm  bark  in  the  same  way  as  the  flaxseed  poul- 
tice. 

58.  Mush  Poultice. — This  is  made  of  corn-meal  mush. 
It  has  no  advantage  over  the  flaxseed  poultice. 


REMEDIES  FOR    LOCAL    LSE.  403 

59.  Bread -and -Mi  Ik  Poultice. — A  popular  and  easily- 
prepared  poultice.  Stale  bread-crumb  is  stirred  into  hot 
milk  until  the  proper  consistency  is  attained.  It  should 
be  kept  hot  a  few  minutes  to  ensure  the  bread  being  well 
softened,  then  spread  and  applied.  Water  may  be  used 
instead  of  milk. 

60.  Bran  Poultice. — When  a  flaxseed  poultice  would 
be  too  heavy,  as  in  some  cases  of  pain  and  tenderness  in 
the  abdomen,  a  bran  poultice  may  be  used.  A  flannel 
bag  is  partly  filled  with  bran,  thoroughly  wet  with  boil- 
ing water,  wrung  out  in  a  towel,  and  applied. 

61.  Hop  Poultice. — Prepared  and  used  exactly  as  is 
the  bran  poultice,  over  which  it  has  no  particular  advan- 
tage except  that  it  is  still  lighter. 

62.  Starch  Poultice. — Thick  boiled  starch  is  spread 
warm  on  a  cloth  and  applied  directly  to  the  skin  without 
any  covering  between.  It  is  used  to  lessen  irritation  in 
some  affections  of  the  skin. 

63.  Mustard  Poultice. — The  same  as  a  mustard  plaster 
(Appendix,  69). 

64.  Charcoal  Poultice. — This  is  made  from  flax- 
seed meal  mixed  with  an  equal  quantity  of  powdered 
charcoal.  More  dry  charcoal  is  sprinkled  over  it  after  it 
is  spread.  It  was  formerly  often  used  as  a  dressing  for 
foul-smelling  sores  and  wounds. 

65.  Jacket  Poultice. — An  application  sometimes  used 
for  pneumonia.  A  piece  of  thin  muslin  or  linen  is  used, 
long  enough  to  go  entirely  around  the  chest,  and  wide 
enough  when  doubled  to  extend  from  the  lowest  ribs  to 


404  THE    CARE    OE   THE   BABY. 

the  collar  bones.  The  cloth  is  opened,  the  hot  mass  of  the 
poultice  spread  on  one  half,  the  other  half  folded  over  it, 
and  the  poultice  applied  as  hot  as  the  child  can  bear  it. 
Oil  silk  or  paraffin  paper  covers  it  externally.  The  poul- 
tice should  be  renewed  ever}'  few  hours,  and  the  new  one 
must  always  be  ready  to  put  on  before  the  old  one  is  taken 
off.  It  should  be  drawn  up  close  under  the  armpits  and 
toward  the  collar  bones  and  fastened  over  the  shoulders 
and  at  one  side  with  pieces  of  broad  tape.  The  open 
edge  of  the  poultice  should  be  above,  in  order  to  prevent 
the  contents  falling  out. 

A  jacket  poultice  of  bran  may  be  made  by  construct- 
ing a  jacket  of  muslin  with  a  lining  of  the  same  sewed  to 
it  everywhere  except  at  a  single  small  opening  through 
which  the  bran  can  be  pushed.  The  poultice  must  be 
quilted  to  hold  the  bran  in  place,  soaked  in  boiling  water, 
pressed  out,  and  applied  when  of  the  right  temperature. 
The  same  poultice  can  be  used  again  and  again. 

66.  Antiseptic  Poultice. — For  use  on  open  wounds, 
surgeons  favor  some  form  of  antiseptic  poultice,  and  ob- 
ject to  flaxseed  and  other  varieties  already  described. 
One  of  the  best  poultices  consists  of  several  layers  of 
cheese-cloth  or  clean  soft  linen  wrung  out  in  a  hot  anti- 
septic fluid  (Appendix,  79),  laid  on  the  wound,  covered 
with  paraffin  paper,  and  bound  on  with  a  roller  bandage. 
This  is  in  reality  a  fomentation  (Aj^pcndix,  54). 

67.  Turpentine  Stupe. — A  piece  of  flannel  is  wrung 
out  in  hot  water,  as  in  preparing  a  fomentation,  and  then 
sprinkled  evenly  with  turpentine,  about  half  a  teaspoon- 
ful  being  used  for  each  square  foot  of  flannel.  It  is  then 
applied,  covered  Vvitli  oil  silk  and  a  dry  towel,  and  left 
on  half  an  hour  to  an  hour,  more  or  less,  depending  on 
the  degree  of  irritation  it  produces. 


REMEDIES   EOR   LOCAL    USE.  405 

68.  Spice  Plaster. — This  is  a  very  serviceable  applica- 
tion for  infants  with  severe  colic.  To  prepare  it  take  i 
part  each  of  ground  ginger,  cloves,  cinnamon,  and  all- 
spice, with  or  without  Yj^  part  of  cayenne  pepper, 
according  as  the  plaster  is  to  be  strong  or  weak.  Put  the 
dry  and  well-mixed  powder  into  a  flannel  bag,  spread  it 
evenly,  and  quilt  the  bag  to  prevent  the  spices  from  get- 
ting into  lumps.  Before  applying,  wet  it  with  hot  alcohol 
or  hot  whiskey.  The  same  spice-bag  may  be  used  repeat- 
edly until  it  begins  to  lose  its  strength  too  greath'. 

69.  Mustard  Plaster. — Strictly  speaking,  this  is  a 
poultice,  since,  as  used  for  children,  the  mustard  is  added 
to  flour  or  flaxseed  meal,  and  the  whole  moistened  and 
heated:  i  part  of  mustard  should  be  mixed  with  3 
or  4,  or,  in  the  case  of  infants,  5,  parts  of  flour  or  flaxseed 
meal.  Boiling  water  is  added  and  the  mixture  stirred 
until  it  is  of  the  proper  softness.  It  is  then  spread  on  a 
cloth  and  applied  directly  to  the  skin.  If  it  burns  too 
much,  a  layer  of  linen  or  some  other  thin  material  can  be 
placed  between.  It  should  be  kept  on  until  the  skin  is 
well  reddened,  but  not  long  enough  to  blister.  A  plaster 
less  apt  to  burn  the  skin  is  prepared  by  mixing  i  table- 
spoonful  of  mustard,  3  or  4  of  flour,  the  white  of  one  &%%^ 
and  I  teaspoonful  of  glycerin.  The  prepared  mustard 
leaves  sold  by  the  druggists  are  usually  too  hot  for  use 
with  children.  They  may  be  employed  in  emergencies, 
however,  mitigating  their  strength  by  covering  them 
with  one  or  two  layers  of  a  wet  pocket  handkerchief. 

70.  Pepper  Plaster;  Nutmeg  Plaster. — These  old- 
fashioned  but  excellent  preparations  are  of  service  in 
mild  bronchitis  or  sore  throat.  Lard  or,  still  better, 
mutton  suet  is  spread  evenly  on  a  cloth  and  black  pepper 


406  THE    CARE    OF   THE   BABY. 

or  powdered  nutmeg  dusted  rather  thickly  over  it.  Red 
pepper  may  be  used  instead,  but  in  smaller  amount.  The 
plaster  may  be  worn  for  days  over  the  chest  or  around 
the  throat.  Another  plaster  is  made  by  mixing  a  very 
little  cayenne  pepper  in  a  thin  paste  of  flour  and  water 
and  applying  on  a  thin  cloth. 

71.  Cotton  Jacket. — This  is  sometimes  ordered  by  phys- 
icians in  cases  of  pneumonia.  A  muslin  waist  should  be 
fitted  to  the  chest,  reaching  high  in  front  and  behind, 
and  tying  or  pinning  over  the  shoulders  and  down  one 
side  under  the  arm.  To  the  inside  of  this  a  thick  layer 
of  cotton  batting  is  loosely  attached.  If  it  is  desired  to 
retain  the  perspiration  and  keep  the  skin  moist,  a  layer 
of  oil  silk  is  sewed  outside  of  the  muslin,  or  the  cotton 
may  be  sewed  directly  to  the  oil  silk,  cut  in  the  shape  of 
a  waist. 

3.   OixTMEXTS. 

72.  Bismuth-and-Zinc  Ointment. 
Subnitrate  of  bismuth,  30  grains; 
Oxide  of  zinc,  30       " 
Lanolin,  Yz  ounce; 
Vaseline,  yi      " 

73.  Ointment  for  Ringworm. 

Sulphur,  Yi  drachm; 

Tar  ointment,  i 

Benzoated  lard,  i  ounce. 

To  be  well  rubbed  in  \.\so  or  three  times  a  day. 

74.  Boric-Acid  Ointment. 

Boric  acid,  i  drachm; 

Vaseline,  ■        i  ounce  ; 


REMEDIES  FOR   LOCAL    USE.  407 

75.   Boric-Acid-and-Zinc  Ointment. 

Boric  acid,  yi  drachm; 

Oxide  of  zinc,  yi        " 

Lanolin,  ^  ounce; 

Vaseline,  ^      ' ' 

4.  Solutions  and  Mixtures. 

j6.  Carbolized  Oil. 

Pure  carbolic  acid  (Calvert's 

No.  i),  y2  drachm; 

Finest  olive  oil,  2  fluidounces. 

This   should  be    marked  "Poison!"      (See   remarks  in 
Appendix,  81.) 

77.  Tannic-Acid-and-GIycerin  Nipple  Lotion. 

Glycerite  of  tannic  acid,  t  flnidounce; 

Water,  i  " 

To  be  painted  upon  the  nipple  and  allowed  to  remain. 

78.  Bismuth  Nipple  Lotion. 

Subnitrate  of  bismuth,  i  ounce; 

Castor  oil,  i  flnidounce. 

To  be  used  as  the  preceding. 

79.  Boric-Acid  Lotion. 

Boric  acid,  i^  ounce; 

Water,  i  pint. 

To  be  used  as  an  antiseptic  wash  in  dressing  wounds. 

80.  Boric-Salicylic-Acid  Lotion. 

Boric  acid,  50  grains  ; 

Salicylic  acid,  8       " 

Water,  8  ounces. 

Used  as  an  antiseptic  lotion  in  cases  of  burns 


408  THE    CAKE    OF  THE  BABY. 

8i.   Carbolic-Acid  Lotion. 

Pure  carbolic  acid  (Calvert's, 

No.  i),  y>  drachm  ; 

Water,  6  flnidoiinces. 

To  be  used  as  the  preceding.     To  be  marked  "  Poison  !" 

Solutions  of  carbolic  acid  should  never  be  applied  by  a 
mother  to  any  but  small  areas  of  skin,  whether  there  are 
ojDen  wounds  or  not,  as  poisoning  by  absorption  has 
repeatedly  occurred. 

82.  Corrosive-Sublimate  Antiseptic  Lotion. 

Corrosive  sublimate,  i^  grains; 

Tartaric  acid,  (:>}{       " 

Distilled  water,  8  fluidounces. 

To  be  used  and  marked  as  the  preceding.     Injurious  to 
metal. 

A  more  convenient  method  of  preparing  it  is  to  dis- 
solve in  3  pints  of  water  one  of  the  sublimate  tablets 
which  are  for  sale  by  druggists.  Either  method  makes 
a  solution  of  the  strength  of  i  of  sublimate  in  3000  of 
water. 

83.  Starch-and-Boric-Acid  Lotion. — Starch  is  to  be 
dissolved  in  the  boric-acid  solution  (No.  79)  in  the  same 
way  as  when  preparing  ordinary  starch-water  (No.  47). 

84.  Borax-and-Glycerin  Lotion. 

Borax,  20  grains; 

Tincture  of  myrrh,  Yz  fluidrachm; 

Glycerin,  i  " 

Water,  enough  to  make  i  fluidounce. 

Apply  frequently  to  the  inside  of  the  mouth  for  inflaniv 
mation  or  thrush. 


REMEDIES  FOR   LOCAL    USE.  409 

85.  Eye  Lotion. 

Boric  acid,  20  grains; 

Camphor-water,  2  fluidouiices. 

86.  Astringent  Gargle. 

Tannic  acid,  1  heaping  teaspoonful; 

Water,  i  tumblerfuL 

Dissolve  and  use  as  a  gargle. 

87.  Tannic-Acid  Solution  for  Nose-bleed. 
Tannic  acid,  2  drachms; 
Glycerin,                                     i  fluidrachm; 
Water,                                         2  fluidounces. 

To  be  injected  or  snuffed  into  the  nose  in  obstinate  cases 
of  nose-bleed. 

88.  Alum  Lotion. 

Alum,  6  drachms; 

Water,  8  fluidounces; 

Alcohol,  8  " 

To  be  used  as  a  wash  in  excessive  perspiration  or  if  bed- 
sores are  threatening. 

89.  Cooling  Lotion. 

Pure  carbolic  acid  (Calvert's  No.  i),  40  grains; 
Ether,  2  fluidrachms; 

Alcohol,  6  fluidounces. 

To  be  dabbed  on  the  parts  and  let  dry.     To  be  marked 
"  Poison  !  "     (See  remarks  in  Appendix,  81.) 

90.  Lotion  for  Freckles.     No.  1. 

Compound  tincture  of  benzoin,  i  fluidrachm  ; 

Glycerin,  }<  fluidrachm  ; 

Rose-water,  3  fluidounces. 


41 0  THE    CARE    OE   THE   BABY. 

91.  Lotion  for  Freckles.     No.  2. 

Borax,  i  drachm; 

Dilute  acetic  acid,  )/>.  fluidounce; 

Rose-water,  ]/>  fluidounce. 

92.  Injection  for  Convulsions. 
Bromide  of  potash,  10  grains, 
Hydrate  of  chloral,  3      " 

Milk  of  asafoetida,  2  fluidounces. 

One  or  two  tablespoonfuls  as  an  injection  for  an  infant. 
To  be  repeated  in  half  an  hour  if  needed. 

93.  Injection  for  Seat-worms. 

Quassia-chips,    i  ounce  (i  small  teacupful); 
Water,  i  pint. 

Let  soak  for  two  or  three  hours.     Inject  slowly  as  much 
as  the  child  will  contain. 

5.   Powders. 

94.  Compound  Camphor  Powder. 
Camphor,  i  drachm; 
Oxide  of  zinc,                                  >^  ounce; 
Starch,                                               Vi  ounce. 

Make  into  a  very  fine  powder. 

95.  Boric-Acid-and-Zinc  Powder. 

Boric  acid,  Vz  ounce; 

Oxide  of  zinc,  ^  ounce. 

Make  into  a  very  fine  powder. 

96.  Bismuth-and-Zinc  Powder. 

Subnitrate  of  bismuth,  Yi  ounce;    • 

Oxide  of  zinc,  Vz  ounce. 

Make  into  a  very  fine  powder. 


remedies  eor  local  use.  4ii 

6.  Disinfectants. 

97.  Carbolic  Acid. 

Carbolic  acid  (Calvert's  No.  4),         6]/i  ounces; 
Glycerin,  4  fluidounces; 

Water,  i  gallon. 

This  forms  a  5  per  cent,  solution  suitable  for  disinfecting 
dishes,  clothing,  thermometers,  metal  work,  and  the 
hands  of  the  nurse.  Clothes  should  be  soaked  in  it  for 
several  hours,  then  wrung  out,  carried  away  in  a  covered 
bucket,  and  boiled  thoroughly.  It  may  be  used  also  to 
wet  the  sheet  hung  at  the  door. 

98.  Chloride  of  Lime, 

Chloride  of  lime,  4  ounces; 

Water  (soft),  i  gallon. 

A  pint  or  a  quart  of  this  is  to  be  thoroughly  mixed  with 
the  passages  from  the  bowels  of  typhoid-fever  cases, 
covered,  and  allowed  to  stand  for  three  hours  before 
emptying.  The  solution  may  also  be  used  to  mix  with 
any  infectious  expectorated  or  vomited  matter. 

99.  Chlorinated  Soda. 

Solution  of  chlorinated  soda,  6  fluidounces; 

Water,  enough  to  make  i  quart. 

Useful  for  disinfecting  the  hands,  eating  utensils  (except 
silver),  etc.,  but  not  so  suitable  for  clothing  as  No.  97. 
It  may  be  used  to  wet  the  sheet  in  front  of  the  door. 

100.  Corrosive-Sublimate  Solution,  No.  1. 
Corrosive  sublimate,  2  ounces  ; 
Tartaric  acid,                                   24 
Carminate  of  soda,  8  grains  ; 
Water,  i  quart. 


412  riJE    CAKE    OF   THE   BABY. 

This  is  the  foriiiula  of  the  Paris  disiiifectin.ti;  service;  4 
ounces  mixed  with  i  gallon  of  water  makes  a  solution  of 
the  strength  of  i  part  of  the  sublimate  in  500  of  water. 
The  blue  carminate  of  soda  is  added  to  give  a  slight  color, 
so  that  the  poisonous  nature  of  the  solution  may  be  easily 
recognized.  The  solution  is  suitable  for  disinfecting 
floors,  wood-work,  leather,  rubber,  etc.  It  must  not  be 
used  upon  metal.  Clothing  may  be  disinfected  by  im- 
mersing it  for  two  hours  in  a  mixture  of  }<  ounce  of  the 
stock  solution  and  i  gallon  of  water.  There  is  some  dan- 
ger, however,  of  its  becoming  stained  by  the  carminate  of 
soda.  The  sheet  in  front  of  the  door  of  the  room  may  be 
moistened  with  a  mixture  of  2  ounces  of  the  stock  solu- 
tion and  I  gallon  of  w^ater. 

loi.   Corrosive-Sublimate  SoJution,  No.  2. — One  of 

the  sublimate  tablets  referred  to  in  No.  82,  dissolved  in  i 
pint  of  water,  makes  a  solution  of  the  strength  of  i  part 
in  1000.  This  is  by  far  the  most  convenient  method  of 
preparing  the  sublimate  solution  for  disinfecting  purposes. 

102.  Disinfectant  Bath. — The  solution  No.  loi,  di- 
luted with  9  parts  of  water,  gives  a  strength  of  i  in 
10,000.  This  may  be  used  either  for  sponging  or  for  im- 
mersion of  the  body  as  a  final  procedure  after  recovery 
from  infectious  diseases.  After  dr}ing,  the  child  is  re 
moved  into  another  room  and  dressed  in  clothing  which 
has  not  been  near  the  sick-room. 

103.  Disinfectant  Vapor. 

Pure  carbolic  acid,  i  ounce  ; 

Oil  of  eucalyptus,  i  fluidounce  ; 

Turpentine,  8  fluidounces. 

Two  tablespoon fuls  may  be  poured  on  a  quart  of  water  in 


REMEDIES  EOR   INTERNAL    ADMINIS'JRAEWN.      413 

a  shallow  j^aii,  and  this  kept  constantly  simmering  in  the 
room  of  a  diphtheritic  j^atient,  for  the  purpose  of  moist- 
ening and  disinfecting  the  air.  Fresh  solntion  must  be 
added  from  time  to  time.  The  flame  must  be  kept  well 
away  from  the  liquid. 

104.  Dry  Disinfectants. — Dry  copperas  (sulphate  of 
iron)  or  chloride  of  lime  may  be  placed  in  large  amounts 
in  water-closets,  water-pipes,  cesspools,  and  the  like,  for 
the  i^urpose  of  disinfecting  them. 

III.  Remedies  for  Internal  Administration. 

105.  Soda-Mint. 

Bicarbonate  of  soda,  ^  drachm; 

Aromatic  spirits  of  ammonia,  ^  fluidrachm; 

Spearmint-water  or  peppermint- 
water,  enough  to  make  2  fluidounces. 
A  teaspoonful  in  hot  water  at  one  year  of  age. 

io6.    Laxative  Alkaline  Mixture. 

Bicarbonate  of  soda,  ^  drachm; 

Spiced  syrup  of  rhubarb,  4  fluidrachms; 

Syrup  of  senna,  4  " 

Syrup  of  orange,  i  fluidounce. 

A  teaspoonful,  more  or  less,  three  times  a  day  at  one  year 
of  age,  depending  upon  the  intensity  of  its  action. 

107.   Chalk-and-Bismuth  Mixture. 

Subnitrate  of  bismuth,  y^A,  drachms; 

Chalk  mixture,  2  fluidounces. 

A  teaspoonful  every  three  hours  or  oftener  at  one  year  of 
age.  A  younger  child  requires  a  dose  not  much 
smaller  than  this. 


414  ^^^^'    CARE    OF   JIJE   HA  BY. 

id^.   Fever  Mixture. 

Sweet  spirits  of  nitre,  i^^  fluidrachms; 

Citrate  of  potash,  30  grains; 

Syrnp  of  lemon,  4  fluidrachms; 

Water,  enough  to  make       2  fluidounces. 
A  teaspoonful  every  three  hours  at  one  }ear  of  age. 

109.  Croup  Mixture. 

Syrup  of  ipecacuanha,        2}^  fluidrachms; 
Bromide  of  potash,  ^  drachm; 

Hive  syrup  i  fluidrachm; 

Cinnamon-water,  I2)^  fluidrachms. 

A  teaspoonful  every  hour  or  two  for  three  or  four  doses 
at  two  years  of  age. 

no.  Jeaunel's  General  Antidote  for  Poisoning. 
{a)  Calcined  magnesia,  2  ounces; 

Animal  charcoal,  i  ounce; 

Water,  20  fluidounces. 

{B)  Monsel's  solution  of  iron,       2  fluidounces. 

When  needed,  the  two  solutions  should  be  mixed  to- 
gether, shaken  hard,  and  given  two  tablespoonfuls  at  a 
time,  repeated  very  frequently. 

III.   Emetics. 
A  teaspoonful  or  more  of  syrup  of  ipecacuanha,  repeated 
in  fifteen  minutes. 

A  glass  of  warm  water  with  as  much  common  salt  as  it 
will  dissolve. 

A  half  teaspoonful  of  alum  stirred  \v^  in  syrup  or  in 
molasses. 


MISCEL  L  ANE  O  US.  4I 5 

A  teaspoonful  of  mustard  in  a  large  quantity  of  warm 
water,  if  other  emetics  fail. 

IV.  Miscellaneous. 

112.  Massage. — This  is  a  procedure  which  no  one  is 
capable  of  carrying  out  as  it  should  be  done  unless  trained 
well  and  long  in  both  its  theory  and  its  practice.  Still, 
where  a  skilled  masseuse  cannot  be  obtained,  the  mother 
or  nurse  can  perhaps  do  something,  and  it  is  certainly 
worth  the  trial;  but  it  should  be  attempted  only  under 
the  advice  and  direction  of  the  physician,  who  can  at  least 
give  some  idea  as  to  what  he  desires  and  the  method  of 
procedure,  even  though  he  be  no  adept  himself. 

Massage  often  does  more  good  in  cases  of  paralysis 
than  any  other  plan  of  treatment.  Children  suffering 
from  general  debility  or  from  chronic  catarrhal  condi- 
tions of  the  stomach  and  bowels  are  often  aided  greatly 
by  it.  Constipation  and  colic  in  babies  are  frequently 
much  relieved  by  rubbing  and  kneading  the  abdomen, 
provided  this  is  done  in  the  proper  way  (p.  272).  There 
are,  indeed,  many  conditions  in  which  massage  finds  a 
useful  sphere. 

There  are  various  technical  terms  used  to  designate  the 
different  manipulations.  Prominent  among  these  are 
effleiwage  (stroking),  friction  (rubbing), //'/r?>j-a^^  (knead- 
ing), and  tapotement  (tapping).  The  method  of  perform- 
ing each  of  these  and  the  conditions  in  which  they  are 
specially  useful  is  far  too  large  a  subject  for  consideration 
in  a  book  of  this  nature,  even  were  it  profitable  to  speak 
further  of  a  matter  for  which  actual  demonstration  is  the 
only  satisfactory  explanation. 

113.  Table  of  Approximate  Equivalent  Measures. — 
The  following  table  shows  the  relative  value  of  drops, 
teaspoonfuls,   fluidrachms,   fluidounces,   etc. : 


4l6  THE   CARE    OF   '11  IK   BABY. 

1  minim  (TTLJ) =1    (Irop    water,    or    2    drops    tinctures, 

spirits,  or  wines. 
30  minims        =\    fluidracbm  (tl^ss)  =  i  coffeespoonful. 
60      "  =1  "  (fl.^j)  =  I  teaspoonful. 

2  fluidrachms =2  teaspoonful?      =  i  dessertspoonful. 

4  "  =1  fluidounce  (n3ss)=4  "  =  i  tablespoonful. 

8  "  =1  "  (fl3J)  =  2  tablespoonfuls. 

2  fluidounces =4  "  =1  wiueglassful. 

8          "           =\  pint    (Oss)  .    .    .  =  I  tumblerful. 
16          "           =1     "      (Oj). 
32  "  =2  pints =1  quart. 

8  pints  .    .      =4  quarts =1  gallon  (Cj). 


For  measuring  minims  we  on.ijht  to  have  one  of  the 
small  minim  glasses  sold  by  druggists 
(Fig.  86).  Very  commonly  medicines 
are  given  by  drops  instead  of  minims. 
In  such  a  ca.se  we  must  never  forget 
that  the  drop  is  of  a  very  variable  size, 
■depending  upon  both  the  nature  of 
the  liquid  and  the  nature  of  the  ar- 
ticle from  which  the  drop  falls.  To 
be  exact  we  should  purchase  an  ac- 
curate medicine-dropper  (Fig.  87), 
and  have  the  druggist  test  it,  no  mat- 
ter how  reliable  it  is  claimed  to  be. 
An  accurate  dropper  will  give  60  drops 
of  water  to  the  fluidrachm;  that  is,  i 
drop  equals  i  minim.  Alcoholic  solu- 
tions, however,  such  as  most  of  the 
tinctures  and  spirits,  and  whiskey  and 
other  stimulants,  drop  about  120  drops 
to  the  fluidrachm;  that  is,  2  drops 
equal  i  minim.  Consequently,  if  the 
physician  orders  a  drop  of  laudanum, 
and  the  mother  uses  the  minim  orlass,  she  must  measure 


Fig.  86. — Minim  glass 
(natural  size). 


MISCELLANE  O  US. 


4U 


out  only  half  a  minim.    Tliis  difference  which  sometimes 
exists  between  the  drop  and  the  minim  is  a  matter  of  the 


F'iG.  87. — Medici ne-droiiper. 

very  greatest  importance.      If  the  accurate  dropper  is  not 
available,  the  medicine  should  be  dropped  from  the  edge 


Fig.  8S. — Method  of  dropping  from  the  edge  of  the  bottle. 

of  the  bottle,  with  the  cork  half  covering  the  opening 

(Fig.  88).     The  dropper  with  very  narrow  pointed  ends, 

so  commonly  sold,  is  useless  for  the  purpose 

as  the  drop  is  too  small.      For  measuring 

larger  doses  teaspoons  and  tablespoons  are 

very  unsatisfactory,  since  they  vary  so  much 

in  size.     The  ordinary  measuring  glasses, 

although  much  better,  are  also  inaccurate. 

It  is  much  wiser  to  purchase  a  four-ounce 

glass  graduate  from  the  druggist  (Fig.  89). 


Fig.  89. —  Four- 
ounce  glass  grad- 
uate. 


114.  Table  of  Proportionate  Dosage  at 
Different  Ages. — The  size  of  a  dose  varies, 
first,   with  the  age  of  the  child  ;  second,  with  its  size  ; 

27 


4l8  THE   CAKE    OF   THE  BABY. 

lliird,  with  the  nature  of  the  disease  ;  fourth,  with  the 
individual  medicine.  There  can,  indeed,  be  no  absohite 
rule,  and  there  are  numerous  exceptions,  for  children 
bear  some  drugs  in  proportionately  much  larger  doses 
than  adults  do,  while  certain  others  the}'  can  take  in  only 
the  minutest  quantities.  As  a  rule,  the  actual  age  is  not 
so  much  the  basis  of  calculation  as  tJiat  age  to  zvhidi  the 
length  and  zveight  of  the  child  coi'vespond. 

The  following  table   forms  a  general    guide   for   the 
different  periods  of  life: 

Adult I 

i8  years |  or  i 

12      "       \ 

8  to  lo  3'ears f 

6  years i 

4  years \ 

3  s 

2  T 

I  year ^ 

9  months tV  =  t  dose  of  i  year. 

6        "         -h  =  \        "        I      " 

Birth  to  3  months -^  =  i       "        ^      " 

115.  Dose  List  for  Children  One  Year  Old. — Accord- 
ing to  the  previous  table  (No.  114),  the  dose  at  2  years  is 
approximately  one  and  a  half  times,  at  3  years  twice,  at 
6  years  three  times,  at  8  to  10  years  four  times  the 
amounts  given  below,  while  the  doses  at  less  than  i  year 
may  likewise  be  determined  by  consulting  the  same  table. 
As  has  been  frequently  stated  elsewhere  in  this  book,  no 
mother  should  attempt  to  prescribe  for  her  child,  espe- 
cially with  powerful  drugs,  such  as  some  of  these  in  the 
following  list  are.  This  list  is  given  solely  for  the  in- 
formation of  trained  nurses — which  they  must  not  put 
.into  practice  unless  forced  to  do  so — and  for  the  sake  of 
that  general  knowledge  which  never  comes  amiss,  and 


MISCELLANEOUS.  4IQ 

which  may  prove  useful  in  cases  of  great  emergency 
where  a  physician  cannot  be  fonnd.  It  is  especially  to 
be  remembered  that  opinni  is  the  drug  to  which  children 
are  particularly  susceptible.  Remember,  too,  the  differ- 
ence between  drops  and  minims,  (See  page  416.)  The 
frequency  with  which  doses  of  the  remedies  should  be 
repeated  is  purposely  omitted,  since  it  depends  absolutely 
upon  the  necessities  of  the  case,  and  can  be  determined 
only  by  a  physician. 

Acetanilid  (antifebrin) gr.  J  to  1. 

Aconite,  tincture r(\^\\.o\. 

Ammonia,  aromatic  spirits  of nt  2  to  4, 

Antimony,  wine  of ttl  2  to  4. 

Antipyrin , gr.  1  to  i 

Asafoetida,  milk  of .    .    .  £5  J  to  i. 

Belladonna,  tincture n\^  J  to  2. 

Bismuth,  subnitrate gr.  3  to  6. 

Brandy  (see  Stwiula?its). 

Bromide  of  potash  or  soda gr.  J  to  4. 

Calomel      gr.  ^  to  ^V  (i  in 

one  single  dose). 
Cascara,. a  tasteless  preparation     ...     tt^  4  to  30. 

Cascara,  fluid  extract o     'il  i  to  4. 

Castor  oil f3  ^  to  i. 

Catechu,  tincture tt\^  5. 

Cinnamon-water .    .    .    .  f3  J  to  i. 

Chalk  mixture f3  i  to  i. 

Chloral gr.  J  to  2. 

Chlorate  of  potash gr.  i. 

Citrate  of  magnesia  (see  Mag7iesid). 

Citrate  of  potash gr.  i  to  2. 

Cod-liver  oil f5  1  to  i. 

Digitalis,  tincture n\^  i  to  i. 

Dover's  powder .    .    .  gr.  i  to  j. 

Epsom  salt gr.  3  to  10. 

Fowler's  solution  of  arsenic       n\,  2  to  i. 

Gin  (see  Stimulants). 

Ginger,  tincture  . ni  i  to  4. 

Hive  syrup  (see  Squills,  comp.  syrup  of). 


420  THE    CARE    OF  THE  BABY. 

Hoffmann's  anodyne n\^  i  to  5. 

Hydrochloric  acid,  dilute ttl  i  to  2. 

Iodide  of  potash     gr.  ^  to  i. 

Ipecacuanha,  S3'rnp  or  wine tT\^  i  to  5. 

Iron,  citrate gr.  il^  to  i. 

Iron,  reduced gr.  ^  to  ^. 

Iron,  syrup  of  iodide         rr;^  i  to  3. 

Iron,  tincture  of  chloride tt\^  .j  to  2. 

Kino,  tincture tr^  5. 

Laudanum.     [A  tincture] Tti  «  to  \. 

Liquorice  powder gr.  2  to  4. 

Magnesia gr.  5  to  20. 

Magnesia,  citrate  (liquid) f3  i  to  2. 

Malt  extract Tt\^  10  to  15. 

Manna gr.  5  to  10. 

Morphine gr.  -^  to  ti 

Nitre,  sweet  spirits  of Tt\^  2  to  6. 

Nux  vomica,  tincture .    .  tt\,  }  to  i. 

Olive  oil f3  i  to  I. 

Pancreatic  extract   . gr.  3  to  5. 

Paregoric.     [A  tincture] n^  3  to  10. 

Peppennint -water f^  2  to  i. 

Pepsin gr.  ^-  to  2. 

Phenacetin gr.  }  to  J. 

Quinine gr.  J  to  i. 

Rhubarb,  syrup  of .... f3  4  to  |. 

Salicylate  of  soda gr.  ^  to  i. 

Senna gr.  i  to  4. 

Senna,  syrup in^  10  to  15. 

Soda,  bicarbonate .  gr.  i  to  2. 

Squills,  comp.  syrup ■n\^  i  to  2. 

Squills,  syrup n\.  i  to  5. 

Stimulants  : 

Brandy tn.  5  to  30. 

Gin Tr\,  5  to  15. 

Port  wine ^  5  to  30. 

Sherry "I  5  to  30. 

Whiskey m.  5  to  30. 

Sulphuric  acid,  dilute in,  ^  to  4. 

Tannic  acid gr.  i  to  I- 

Whiskey  (see  Stimulants). 
Wine  (see  Stinmlants). 


MISCELLANE  O  US.  42 1 

ii6.  Medicine  Closet. — The  contents  of  the  medicine 
closet,  to  which  reference  was  made  in  Chapter  X. ,  p.  232, 
should  be  somewhat  according  to  the  following  list.  This 
contains,  among  other  things,  articles  useful  for  accidents, 
including  poisoning.  The  list  may  be  curtailed  in  some 
respects,  but  suffers  consequently  in  completeness.  Those 
liquids  marked  with  an  *  are  for  external  use  or  are  dan- 
gerous.    They  should  be  in  poison-bottles. 

List  of  Articles  for  Medicine  Closet. 

Glass  graduate  marked  with  fluidrachms  and  fluid- 
ounces;  minim  glass;  accurate  dropper;  hard-rubber 
syringe  holding  four  or  six  ounces;  small  druggist's 
hand  scales  for  weighing  medicines;  camel's -hair 
brushes;  small  straight  dressing-forceps;  a  pair  of  scis- 
sors; absorbent  cotton;  several  one-inch  and  two-inch 
roller  bandages,  one  to  three  yards  long;  patent  lint;  old 
linen;  a  spool  of  rubber  adhesive  plaster;  court  plaster; 
paraffin  paper  or  oil  silk;  *  alcohol;  whiskey;  olive  oil; 
*  ammonia-water  ;  *  turpentine  ;  glycerin  ;  *  distilled  fluid 
extract  of  hamamelis  (witch-hazel)  for  bruises  ;  *soap  lini- 
ment for  sprains  ;  *  tincture  of  iodine  ;  *  solution  of  boric 
acid  for  washing  cuts  (Appendix,  79)  ;  flaxseed  meal  ; 
mustard;  magnesia;  vaseline;  castor  oil;  zinc  ointment; 
soda-mint;  baking  soda;  sweet  spirits  of  nitre;  aromatic 
spirits  of  ammonia;  bromide  of  potash  in  20-grain  pow- 
ders, to  be  divided  according  to  the  age;  *  tincture  of 
digitalis;  syrup  of  ipecacuanha;  tannic  acid  for  use  in 
poisoning;  Epsom  salt  for  poisoning;  vinegar  for  poison- 
ing; sulphate  of  copper  in  3-grain  powders,  for  poisoning 
by  matches;  Jeaunel's  antidote  for  poisoning. 


INDEX. 


Abdomen,    conditions  of,  in   disease 
241 
enlargement  of,  in  colic,  274 
in  pregnancy,  20 
in  rickets,  339,  340 
massage  of,  272,  415 
of  child,  size  at  birth,  36 
Abdominal  band.     See  Binder. 

belt  for  pregnancy,  26 
Accidents,  357 
Adenitis,  343 

Adenoid  growths,  238,  268 
Air,  fresh,  in  pregnancy,  22 
moistening  of,  217,  229,  332 
out-door  exposure  to,  178,  179 
Albumen-water,  382 
Alum  solution,  395,  409 
Amusements,  I85-188 

in  pregnancy,  24 
Antiseptic  lotions,  408,  411,  412 
Appetite,  loss  of,  252,  268,  346 
Applications,  external,  256,  259,  393 
Apron,  bath-,  71 

creeping,  107,  181 
Arms,  short,  at  birth,  37 
Arrow-root  jelly,  383 

-water,  383 
Atomizer,  bulb,  260 
steam,  230,  282 

Baby,  characteristics  of,  in  health,  34 

jumper,  182 

method  of  carrying,  177,  254,  363 

sensations  of,  50 

use  of  the  term,  18 
Baby's  basket,  68 
Backwardness,  292 
Bag  of  waters,  t^t, 
Bandage.     See  Binder'. 

roller-,  method  of  applying,  357 


Barley  and  ^g^,  382 

jelly,  382 
-water,  381 
Barrel-hoops  to  keep  covers  off,  398 
Barrow  coat,  92 
Basin,  sponge-,  75 
Bassinet,  172 
Bath -apron,  71 

blanket,  398 

bran,  400 

daily,  73 

disinfectant,  400,  412 

duration  of,  72,  79,  82,  396 

fear  of,  76 

first,  70 

foot,  400 

for  a  prematurely  born  child,  337 

graduated,  396 

hot-air,  398 

hour  for.  So 

method  of  giving,  71 

mustard,  398 

powder  after,  81 

salt,  399 

sheet,  397 
shower,  397 
soap  for,  78 
soda,  399 
sponge,  394 
starch,  399 
sulphur,  400 

temperature  of,  72,  78,  80,  394 
thermometer,  79 
towels  for,  81 
tub-,  72,  395 
vapor,  398 
water  for,  78,  79 
Bathing.     See  also  Bath. 
during  pregnancy,  22 
for  sleeplessness,  81,  288,  396,  397 

423 


424 


IXDEX. 


Batliing,  imfortance  of  tub-,  76 

room  for,  222 
Ballis  in  iliscase,  256,  393 

out-dour,  82 
Lialh-tub,  73,  74,  76 

stand  for,  73,  74 
Bed,  airing  <>f,  175 
-clothes  fasteners,   176 
confinement  to,  during  siclcness,  254 
-covers,  174,  175,  254 
for  confinement,  31 
for  infant,  172 
furnisliing  of,  174 
in  sickness,  255 
-room  slioes,  1 1 5 
trundle-,  174 
warming  of,  175 
-wetting,  348 
Beef-juice,  162,  164,  387 
effect  on  urine,  247 
-tea,  386 

peptonized,  391 
Bibs,  106,  107 
Bicycle,  185 
Binder  for  child,  89,  lOO,  108,  109 

for  mother,  31,  32 
Birth-marks,  25,  304 
-palsy,  289 
premature,  337 
Bismuth-and-zinc  ointment,  406 

powder,  410 
Bismuth  nipple  lotion,  407 
Bites  of  animals,  360,  361 
Bladder,   irritability  of,  in  pregnancy, 

28 
Blanket,  pinning  of,  92 
shoulder,  97 

to  receive  baby  at  birth,  70,  71,  97 
Bleeding,  arrest  of,  357,  358 
from  navel,  304 
from  nose,  371 
Blindness,  congenital,  293 

from  inflammation  of  the  eyes,  293 
Blue  baby,  350 

Body,  feebleness  of,  in  idiocy,  292 
-movements  in  early  life,  47,  48 
Boils,  266,  309 

Bones,  broken  or  displaced,  362 
Boots,  rubber,  114 
Borax-and-glycerin  lotion,  408 
Boric-acid-and-zinc  ointment,  408 

powder,  410 
Boric-acid  lotion,  407 


Boric-acid  ointment,  406 
Jioric-salicylic-acid  lotion,  407 
Bottle-feeding.     See  Feeding,  artifitial. 
Bottle,  feeding-.     See  Nursing-boltlc. 

for  poisons,  232 

-tip.     See  Nipple, 
Bowel,  closure  of,  276 

inflammation  of,  270 

itching  of,  238,  278 
Bowel-movements.     See  Passages. 

prolapse  of,  276 
Bowels,  teaching  c<jnirol  over,  52,  184 
Bow-legs,  37,  103,  182,  299,  340 
Brain,  concussion  of,  367 

disease  of,  238-243,  268,  288-292, 
298 

water  on  the.     See  Hydrocephalus. 
Breast,  abscess  of,  124,  1 27,  343 

caked,  124 

feeding  at.     See  Feeding. 

-pump,  27 
Breasts,  care  of,  27,  123,  124 

distention  (jf,  124,  126,  345 

enlargement  of,  in  jiregnancy,  20 

inflammation  of,  in  infants,  345 
Breath,  holding  the,  355 
Breathing.     See  Respiration. 
Bright's  disease,  239,  247,  34S,  398 
Bronchitis,  283,  405 
Brooder,  337 
Bruises,  361 
Brush  for  head,  85 

for  throat,  259 

tooth-,  84 
Burning  child,  364 
Burns,  363,  365 

Cap,  98,  108,  113.  115 
Carbolic-acid  antiseptic  lotion.  408 

disinfectant  solution,  4II 
Carbolized  oil,  407 
Carriage,  180,  181 

"express-wagon,"  183 

prevention  of  falling  from,  iSo 
Carry'ing  the  child  in  sickness,  254,  363 

method  of,  177 
Cart,  183 
Cereals,  163,  166 
Chafing,  30S 
Chair-car,  I  S3 

nursing-,  184,  220,  272 
Chairs  for  nursery,  220,  222 

for  school-room,  235 


INDEX. 


425 


Chalk-and-bismuth  mixture,  413 

Cliapping,  309 

Characier,   training   of^   1S7,  18S,  193, 

205 
Chest  in  disease,  240 

in  health,  36,  60 
Chicken-breasted,  240,  268 

-pox,  324,  326 
Chilblains,  367 

Childbirth.      See  Confinement. 
Childhood,  disorders  of,  237,  263 

early  and  later,  definition  of,  18 
Child's  nurse.      See  Ahirse-maid. 
Chloride-of-lime  solution,  411 
Chlorinated-soda  solution,  411 
Choking,  371 
Cholera  infantum,  270 
Chorea,  2S9 
Cleft  palate,  263 
Cloak,  98,  108 

Clothes-basket  for  early  exercise,  181 
Clothing.    See  also  Petticoat,  Skirt,  etc. 

after  shortening,  loi,  108 

difference    in    heat    depending    on 
color,   1 1 1 

different  styles  of,  for  infants,  92 

disinfection  of,  226 

during  pregnancy,  26 

during  sickness,  1 15 

for  different  sexes,  iii,  113 

for  night,  97,  113 

for  out-doors,  98,  loS,  1 12 

general  remarks  on,  86 

in  couveuse,  338 

of  childhood,  loq,  1 15 

of  infancy,  88,  108 

undergarments,  material  for,  87 
Club-foot,  37,  298 
Coat,  108,  114 

rubl)er,  114 
Cold,  application  of,  257 

effect  of,  on  child,  34,  87,  366,  367 

in  the  head,  2S0 
Colds  treated  by  bath,  306,  400 
Colic,  119,  239.  241,  274,  415 
Color  of  skin,  34,  35,  239 
Colors,  absorption  of  heat  by,  1 1 1 
Colostrum,  117 
Coml),  85,  313 
Comforter,  156 

Comjiound  camphor  |>owder,  410 
Compresses,  wet,  394,  401 
Confinement,  "  bag  of  waters,"  33 


Confinement,  bed  for,  31 
binder,  31,  32 
calculating  date  of,  2I-23 
napkins,  32 
pains  of,  T,^ 
preparations  for,  30 
room  for,  31 

,   "  show,"    T,T, 

Constipation,  271 

in  pregnancy,  28 
Consumption,  239,  240 
Contentment,  188 
Convulsions,  238,  239,  2S4,  396 
Cooling  lotion,  409 
Cord,  navel.     See  A^avcl  cord. 
Corrosive-sublimate    antiseptic    lotion, 
408 

disinfectant  solution,  411 
Corsets,  1 13 
Coryza,  280 
Cotton  undtrwear,  88 
Cough,  signification  of,  242 
Couveuse,  337 
Cow-pox,  327 
Cracks  in  skin,  309 
Cradle,  173 
Cream,  129,  130,  140,   141,  143 

-and-barley  water,  160 

-and-whey  mixture,  160,  385 

testing  of,  140 
Creamometer,  129,  130,  140 
Creeping,  48,  181 

apron,  107,  181 

pen  for  early  exercise,  182 
Crib,  173,  174 
Croup  kettle,  230,  282 

membranous,  283 

mixture,  414 

spasmodic,  28 1 

tent,  230 
Cry,  signification  of,  38,  1 18,  241,  349 
Curd,  "  breaking  of,"  161 
Cui"vaturc  of  spine.      See  Spine. 
Cuts  and  tears,  357 

Dancing,  1S5 
Dandruff,  31 1 
I5ay  of  the  disease,  315 
Deafness,  2S1,  292,  296 
Dentition.     See  also  TeetJi  and   Teeth- 
ing. 

delaved,  66 

disordered,  62,  265 


426 


INDEX. 


Despondency  in  pregnancy,  24 
Desquamation,  318 
Diajjer-cover,  rubber,  91 

-drawers,  103 

-squares,  91 

-suspenders,  103 
Diapers,  l)aby,  90 

leaving  oft  of,  109 
Dianh<ea,  239,  241,  255,  269 
Diet.     See  also  Food  and  Feeding. 

after  tliree  years,  166 

after  weaning,  162 

from  eighteen  months  to  two  years, 
164 

from  one  year  to  eighteen  months, 
163 

from  two  to  three  years,  165 

influence  on  breast-milk,    121,    122, 

131 

in  pregnancy,  25 

necessity  of  caution  in  changing,  124, 
158,  163,  164-166,  253,  261, 
262 
of  nursing  mother,  120,  131 
Dietary,  261,  381 
Diphtheria,  290,  329 
Dirt,  eating  of,  352 

Diseases,  contagious,   196,    212,    225- 
228,  314 
due   to   unhygienic  school-room  and 

schooling,  195,  234 
features  of,  237 
infectious,  196,  212,  314,316 
of  l)oncs,  muscles,  skin,  etc.,  297 
of  brain  and  nervous  system  and  of 

the  special  senses,  284 
of  digestive  apparatus,  263 
of  organs  of  respiration,  280 
record  of,  261,  262 
Disinfectant  l)ath,  412 

vapor,  332,412 
Disinfectants,  41 1 

d'T,  413 
Disinfection  about  body,  uselessness  of, 

31.5 

in  contagious  diseases,  226 

of  wasli-staiid,  221 
Dislocations,  362 
Disorders  of  childhood,  263 

of  pregnancy,  28 
Disposition,  aiterntion  of,  in  pregnancy, 

21 

Dog-bites,  360 


Donkey,  186 

Dose  of   common    remedies    for   chil- 
dren one  year  old,  251,  418 
size  of,  at  difl'erent  ages,  417 
Drachm,  fluid,  416 
Draughts,  70,  181,  216,  217,  218,  228, 

234 
Drawers,  102,  103,  108,  109,  115 

night-,  113,  115 
Dress  for  childhood,  109,  III 

or  slip  for  infancy,  95 
Dressing,  method  of,  98 

the  cord,  98,  99 
Drops,  416 
Dropsy  in  children,  241,  347,  398 

in  pregnnncy,  29 
Drowning,  374 
Drying,  73,  81 

Earache,  295 

Ears,  foreign  bodies  in  tlie,  370 

inflammation  of,  281,  295 

injury  by  Ijatli,  77,  83 

protruding,  298 

washing  of,  77 
Eczema,  241,  306,  311,  313,  373 
Emergencies,  357 
Emetics,  414 
Eiicmata  for  convulsions.  410 

for  thread-worms,  410 

nutrient,  392 

syringes  for,  257,  25S 
Epilepsy,  286,  287 
Eruptions,  jiustular,  309 
Erysipelas,  327,  328 
Erythema,  309 
Exercise,  calisthenic,  1S7 

cl othcs-ba.sk et  or  pen  for,  181,  1 82 

express -wagon  or  mail-cart  for,  183 

for  nursing  mother,  122 

gymnastic,  187,  196 

infant's  earliest,  177 

in  pregnancy,  22 

large  amount  borne  by  child.  1 85 

length  of  out-door  walk,  1S2 

trotting  on  knee.  184 
Expectoration,  age  wlien  begun,  283 
Express-wagon,  183 
Eye,  acid  in  the,  369 

dropper,  294 

foreign  bodies  in  the,  368 

lime  in  the,  369 

lotion,  409 


INDEX. 


427 


Eye,  wounds  of  the,  369 

Eyelashes,  effect  of  cutting,  85 

Eyes,  care  of,  72,  77,  9S,  180,  214,  235 

color  of,  37 

crossing  of,  239,  2S5,  290,  295 

half-open,  240 

inflammation  of,  23S,  293 

injury  of,  by  study,  195,  235,  288 

purplish  tint  about,  239 

washing  of,  72,  77 

Face,  expression  of,  in  disease,  239,  240 

in  health,  37 
Fainting,  374 
Falling  backward,  49 
Falsehoods,  1S9,  205 
Fearlessness,  192,  207 
Features  of  disease,  237 
of  health,  34-36,  237 
Feeble-mindedness,  291 
Feeding.     See  aho  Ahcrsing,  Diet,  and 
Food.  ' 

artificial,  132 
at  the  breast,  116 

action  on  womb,  117 
disadvantages  to  mother,  125 
length  of  time  for,  120 
method  of,  119 
bottle-.     See  Fcedittg,  aiiificial. 
-bottle.     See  Ntirsing-bolile. 
by  wet-nurse,  131 
frequency  of,     1 17,    134,    163,    164, 

from  the  bottle,  155 

discontinuance  of,  162 
length  of  time  for,  155 
position  of  baby,  155 

from  cup  or  spoon,  126 

general  rules  for,  134 

hours  for,  135,  1 63- 1 65 

in  cleft  palate,  263 

in  first  day  or  two  of  life,  1 17 

in  sickness,  168,  252,  261,  381 

prematurely  born  children,  338 

with  stomach-tube,  258 
Feet,  cold,  43,  106,  275,  347 

deformity  of,  298 

turned  in  at  birth,  37 
Fever,  46,  245,  345 

baths  for,  395-39^ 

-blisters,  310 

giving  of  water  in,  253,  346 

-mixture,  414 


Fever,   relation  to  pulse   and   respira- 
tion, 245 
Fevers,  eruptive,  315 
Fire,  child  a-,  364 

-place,  215,  218,  229 
Fish-hooks,  wounds  by,  359 
Fits.      See  Convulsions. 
Flaxseed  tea,  383 
Floor,  draughts  on,  181,  216,  218 

playing  on,  181,  2l8 
Flour-ball,  385 
Flowers  in  nursery,  220 
Fomentations,  401 
Fontanelles  in  disease,  240,  291,  339 

in  health,  36,  60 
Food.    See  also  Diet,  Feeding,  and  JMilk. 

abstinence    from,  in    acute    disease, 
253,  261,  269,  271,  275 

cereal,  167 

character  of,  for  baby,  1 16,  136 

gelatin,  160,  384 

heating  of,  155,  233 

increase  of  fat  in,  272 

peptonized,  160,  387,  393 

prepared  beef,  386,  393 

quantity  required,  132 

relation  to  size  and  weight,  135 

starchy.      See  Starch. 

table-,  injuriousness  of,  161 

to  suit  individual  chikl,  157 

warming  of,  154 
Foods,  patented  infants',  138,  158 

permitted  after  three  years,  167 

to  be  avoided,  168 

to  be  taken   cautiously,  167 
Foot,  clubbed,  298 

reproduction  of  imprint  of,  106 
Foreign  bodies  in  the  ear,  370 
in  the  eye,  368 
in  the  nose,  371 
swallowing  of,  370 
Foreskin,  iian'ow,  349 

washing  of,  77 
Forwardness,  192 
Fractures,  362 
Freckles,  366,  409.  410 
Freezing,  366 
French  measles,  323 
Frights  during  pregnancy,  25 
Frost-bite,  366 
Fruit,  165,  167,  272,  342 
Fumigation,  method  of,  226 
luu'uncle,  310 


428 


INDEX. 


{".AMKS  and  sports,  185-188 

CJargle,  409 

Gastric  juice,  62 

Gate  to  luirseiy,  219 

Gavage,  25S 

Gelatin  solution,  3S4 

Gentleness,  191 

German  measles,  323 

enlarged  giaiuls  in,  343 

Gertrude  suit,  93.  95,  96,  99,  loi 

Gestures  in  disease,  23S 

Glands,  abscess  of,  321 
enlarged,  343 

Go-cart,  183 

Governess,  206,  234 

Gown,  night-,  97,  100,  113 

Graduate,  glass,  252,  417 

Gravel,  247 

Grinding  of  teeth,  247.  278,  285 

Grippe,  335 

Growth,  general  remarks  on,  46 

Gruel,  peptonized,  391 

Gum-arabic  water,  383 

Gum-boil,  266 

Gums.     See  also  Month. 
lancing  of,  62,  266 
rubbing  tooth  through,  266 

Gymnasium,  187 

Habits,  337 
Hair-brush,  85 
Hair,  care  of,  77,  85 

change  of  color  of,  61 

new  growth  of,  61 

on  body,  34 

on  head,  foiling  out  of,  30,  36,  61 
Hand,  movement  of,  to  seat  of  j-iain,  238 
Hands,  cold,  275.  346,  347 

deformity  of,  298 

hot,  relation  to  fever,  346 
"  Hardening,"  87,  17S 
Hare-lip,  263 
Hat,  113,  115 
Head,  deformity  of,  at  birth,  35,  297 

fontanelles.      See  Fimtanelles. 

holding  erect,  48,  201 

in  disease,  238,   240 

pers]iiration  of,  240,  330 

size  and  sha]ie  of,  35,    60,   240,  291, 

297.  .>39 
Headache,  288 
Health,  features  of,  34,  237 
Hearing  at  birth,  47 


Hearing,  increase  in  jiower  of,  49 

in  idiocy,  292 
Heart  disease,  341,  343 

congenital,  350 
Heat,  application  of.  25*^1 
Heating,  methods  of,  217,  228 
Height.     See  Length. 
Hemorrhage.     See  B/cii/ini;. 
HemoiThoids  in  jiregnancy.  29 
Hernia,  277 
Hiccough,  345 
Hip-joint  disease,  300 
Hips  at  birth,  36 
Hives,  307 

Hoarseness,  242,  28 1,  2S3,  322,  33 1 
Hood,  98,  114 
Hoop,  rolling  of,  185 
Horse-back  riding,  186 
Hydrocephalus,  240,  2)1,  298 

Ice,  method  of  keeping.  233 

-bags,  257 
Idiocy,  291 

Imitation,  power  of.  189 
Incubation,  stage  of,  315 
Incubator,  337 
Indigestion,  clironic,  239,  268 

in  pregnancy,  30 
Infancy,  dehnition  of,  18 
Infectious  diseases,  table  of,  316 
Influenza,  335 
Initial  symptoms,  317 
Injections.     .See  Encmata. 
Inquisitiveness,  1S9 
Insomnia,  287,  396,  397 
Intellect.     See  Minit. 
Intelligence.     See  al<o  Mind. 

at  birth,  37,  47 

growth  of,  48.  50 
Invasion,  stage  of,  316 
Isolation,  318 
Itch,  312 

Jacket,  cotton,  406 
jaundice,  35,  230,  279 
Jaunting  car,   I  S3 
Jaw,  V-shaped,  352 
Jeaunel's  general   antidote  for  poison- 
ing. .S77.  4 '4.  421 
Joints,  dislocation  of,  362 
enlargement  of,  339,  341 

Kindergarten,  194 
Knock-knees,  299,  340 


INDEX. 


429 


T^AHOR.     See  Confinement. 
Lactometer,  139 
Lameness,  301 
La|>protcctor,  loi 
Laryngitis,  242,  2S2,  283 
Larynx,  spasm  of,  355 
Laughing,  50 

Laxative  alkaline  mixture,  413 
Layette,  100 
Leggings,  loS,  114,  1 15 
Legs,  bending  of,  37,  182,  341 

crooked,  at  birth,  37 

short,  at  birth,  37 
Length  at  birth,  34,  54 

increase  in,  53^59 

measure  for  determininL,s  ^8 
Leucorrhoea  in  childhood,  349 

in  pregnancy,  30 
Lice,  313 

Lifting  the  baby,  177 
Lighting,  methods  of,  223,  236 
Lime-water,  387 

disadvantages  of,  151 
Lip-sucking,  352 
Lisping,  353 

Lists.     See  Tables  and  Lists. 
Liver  at  birth,  36 
"  Longings,"  21 
Lotions,  407-410 
Lungs,  congestion  of,  283 

inflammation  of,  283 
Lying,  189,  21 1 

Macule,  31S 
Mail-cart,  I  S3 
Management  of  pregnancy,  22 

of  sick  children,  248 
Marasmus,  240,  344 
"  Markings"  on  children,  25,  304 
Massage,  1S7,  272,  415 
Masturbation,  356 
Maternal  impressions,  25,  304 
Mattress,  material  and  protection  of,  31, 
174 

renovating,  227 
Meals,  number   and    hours,    134,   135, 

163,  167,  16S 
Measles,  239,  322 

French,  323 

German,  323 

glands  in,  343 
Measure  for  determining  length,  58 

for  milk-sugar,  144 


Measures,  table  of  equivalent,  416 
Measuring  of  medicines,  251,  416 
Meconium,  41,  117 
Medicine  closet,  232,  421 
-dropper,  416 
-glasses,  252,  417 
method  of  giving,  248-252 
Medicines,  care  of,  22S,  232,  377 

size  of  dose  of,  251,  416,  417 
Meigs'  gelatin  food,  160,  384 
Membranous  croup,  283,  330 
Menstruation  absent  in  pregnancy,  20 

influence  of,  (jn  breast-milk,  127 
Merino  underwear,  88 
Miliaria,  305 

Milk.     See  also  Feeding  and  Food. 
acidity,  test  for,  141 
amounts  at  different  ages,  134 
ass's,  137 

boiled,  138,  148,  152 
breast,  1 16 

analysis  of,  137 
approximate  analysis  of,  130 
best  nourishment  for  child,  116 
influence  of  diet  on,  121,  122,  131 
of  drugs  on,  121 
of  emotions  on,  122 
of  menstruation  on,  127 
of  pregnancy  on,  127 
insufficient  supply  of,  122,  127 
modihcation  of,  131 
quantity  secreted,  I20 
time  flow  begins,  116 
-cake,  124 
casein  of,  138 

cleanliness  required,  139,  147 
condensed,  159 
cow's,  analysis  of,  137 

artificially  colored,  test,  141 
care  of,  139 

characteristics  of,  137-139 
cream  of.     See  Cream. 
■crust,  311 

fat  in,  128,  131,  137,  13S,  142 
goat's,  137 
mare's,  137 
mixture,  formula  for,  143,  146 

increasing  strength  of,  162 
mixtures  to  substitute  mother's  milk, 
general  remarks  on,  13 1,  132, 

Pasteurized,  152,  390 
peptonized,  389-391 


430 


I\DEX. 


Milk,  poisonous,  122,  147 
punch,  pc-ptoni/fd,  160,  392 
rci^uri^italion  of,  120,  269 
salt  adileil  to,  143,  252 
sterilized,  147 

digcsliinlily  of,  152 
for  travel! i lit;;,  15 1 
preservation  of,  151 
-sugar,  142,  143 

measure  for,  I44 
teeth.     See  Teeth. 
testing  of,  I39 
-toast,  peptonized,  392 
top,  144 

wet-nurse,  no  influence  on  traits  of 
child,  201 
Mind.     See  also  Inie/ligL-nce. 
effect  of  pregnancy  on,  24 
over-use  of,  194,  195 
training  of,  187,  192,  193,  195,  205 
Minim  glass,  416 
Minims,  416 

Miscellaneous  disorders  and  habits,  337 
Mittens,  98,  100,  108 
Moccasins,  104 
Mole,  304 
Monthly  nurse.     See  Nurse. 

periods.     See  JMcnstruaiion. 
Moral   character,  training  of,  1SS-194, 

204 
Morals,  supervision  over,  193 
Morbilli,  322 
Mosquito-bites,  360 

Mother,  disadvantages   of   nursing    to, 
125 
ignorance  of,  17 
Mother,  nursing-,  diet  of,  120,  122,  131 
exercise  and  fresh  air  fur,  122 
use  of  stimulants  by,  121 
Mother's  marks,  304 
Mouth,  appearance  in  teething,  63 
-breathing,  238,  268,  350 
hand  in,  238 

inflammation  of,  264,  265 
wa.sliing  of,  72,  83,  251,  255,  265 
Movement,  i)ain  on,  238 
Movements  of  body  at  birth,  47 
increase  in  ]50\ver  of,  48 
in  disease,  238 
in  health,  37 
of  bowels.     See  Passages. 
Mumps,  335 
Music,  percejition  of,  49 


Ni^vus,  304 
Nails,  biting  the,  353 
care  of,  85 

condition  at  birth,  36 
toe-,  ingrowing,  299 
Napkins  fur  baby.     See  Diapers. 

for  confinement,  32 
Nature,  love  of  objects  in,  191 
Nausea,  239 

Navel,  bleeding  from,  304 
cord,  dressing  of,  98,  99 

falling  oft"  of,  99 
ulcer  of,  304 
washing  of,  77 
Neatness,  188,  206,  212 
Needle,  wound  by,  359 
Netlle-ra-sh,  307 
Night-clothes,  97,  100,  108,  1 1 3,  115 

-terrors,  286 
Nightmare,  2S7 
Nipple,  artificial,  123 
for  cleft  palate,  263,  264 
-protector,  27 
rubber,  care  of,  156 

collapsing  of,  156,  157 
-shield,  123 
ventilated,  157 
with  tube,  objection  to,  157 
Nipples,  care  of,  during  nursing,  1 23 
during  pregnancy,  27 
fissures  of,  27,  119,  123,  124 
hardening  of,  27 
retracted,  27,  1 1 7,  1 23 
Noise  natural  U>  child,  1S9 
Nose,  foreign  bodies  in  the,  371 

picking  at,  23S 
Nose-bleed,  371,  409 
Nostrils,  moving  of,  240 
Number,  idea  of,  51 
Nurse,  child's.     See  Nurse-maid. 
"experienced,"  198,  205,  211 
monthly,  choice  of,  197 
duties  of,  198 
incompetence  of,  17 
trained,  dress  of,  212 
duties  of,  211,  212,  248 
privileges  of,  212 
qualifications  of,  211 
record  kept  by,  261,  262 
wet-,  hygiene  of,  201 

milk  without  influence  on  traits  of 

child,  201 
objections  to,  131 


INDEX. 


431 


Nurse,  wet-,  qualifications  of,  199 

supervision  over,  201 
Nurse-maid,  age  of,  204 

"  dent's  "  for,  207 

duties  of  mother  to,  208 
to  the  child,  207 

French,  209 

(German,  209 

(jualilicalions  of,  203-206 

supervision  over,  202,  209 

uutrustworthiness  of,  202 

upholding  authority  of,  209 
-maids,  training-school  for,  206 
Nursery,  attractiveness  of,  220 
ceiling,  floor,  and  walls,  219 
chair,  184,  220,  272 
cleanliness  of,  220 
cloth,  31 
day,  214 

flowering  plants  in,  220 
furnishing  of,  219,  222 
gate  to,  219 
governess,  206 
heating  of,  217 
lighting  of,  223 
night,  221 
pictures  in,  219 
position  in  house,  214,  222 
refrigerator,  233 
size  of,  215 

temperature  of,  218,  222 
ventilation  of,  21 5-2 1 8,  222 
wash-stand  in,  221 
windows  to,  214,  216,  217,  218,  219 
Nursing.     See  also  Feeding. 
-bottle,  154 

smoothness  of,  156 

sucking  at,  when  empty,  155 

ventilated,  157 

washing  of,  156 

with  long  tulie,  157,  265 
influence  of  pregnancy  on,  127 
manner  of,  by  sick  child,  247 
of  contagious  disease,  212,  225-228 

Oatmi.al-water,  3S2 
Obedience,  190,  19I,  249 
Ointments,  406 
Onset  of  disease,  317 
Ophthalmia,  293 
Orange-juice,  165,  1 67,  272 
Ounce,  fluid-,  416 
Oysters,  peptonized,  391 


Pack,  wet,  397 

Pain,  growing,  301,  342 

in  knee  and  hip,  300 

on  movement,  238,  241,  339,  341 

on  passing  urine,  348,  349 

result  of  chilling,  275 
Pains  during  confinement,  t,t, 
Pajamas,  113 
Palate,  cleft,  263 
Palsy,  289 

Pancreatic  juice,  161 
Papule,  318 
Paralysis,  289 

at  birth,  2S9 

dijjhtheritic,  290,  331 

position  in,  238 

spinal,  290 
Parties,  children's,  192 
Passages,  habit  of  regularity,  184,  272 

meconium,  41,  117 

mucus  in,  268-270 

number    and    color  in   disease,  24S, 
269-277 
in  health,  41,  42,  67 

sponging  after,  79 

straining  at,  270,  272,  276 
Pasteurizing,  149,  152-154 
Pediculi,  313 
Pen,  creeping,  182 
Peptogenic  milk  powder,  391 
Peptonized  beef  enema,  393 
foods,  388 
-tea,  391 

egg  enema,  393 

food,  160,  387 

grael,  391 

milk,  160,  389,  390.  391 
-punch,  392 
-toast,  392 

oysters,  391 
Perambulator.     See  Carriage. 
Perspiration  of  head,  240,  339 

powdering  for,  306 

sponging  for,  395 
Pertussis,  332 
Pets,  191 
Petticoat,  92 

Gertrude,  93,  95 
Phimosis,  349,  356 
Pigeon-toeil,  49,  299 
Piles  in  jiregnancy,  29 
Pillow,  175 

on  which  to  cany  child,  loi 


432 


INDEX. 


Pillows,  renovating,  227 
I'llls,  melliod  of  giving,  25 1 
Pint,  416 
Plaster,  mustard,  405 

nutmeg,  405 

pepper,  405 

spice,  405 
Play,  48,  187 
Pleasure,  sensations  and  expression  of, 

50 
Pleurisy,  240,  241 
Pneumonia,  283 
Poison-bottle,  232 

elder,  373 

-guard,  232 

ivy,  372 

oak,  372,  373 

sumach,  372 
Poisons  and  antidotes,  377,  414,  421 

swallowing  of,  376 
Pony,   186 
Position  during  sleep,  169 

in  disease,  237,  254 

in  health,  38 

necessity  of  changing,  169 

when  nursing,  1 19 
from  bottle,  155 
Pott's  disease  of  spine,  240   302 
Poultice,  antiseptic,  404 

bran,  403,  404 

bread-and-milk,  403 

charcoal,  403 

flaxseed,  402 

hop,  403 

jacket,  403 

mush,  402 

mustard,  403 

slippery-elm,  402 

starch,  403 
Poultices  and  plasters,  402 
Powder  after  bath,  73,  81 
Powders,  410 

method  of  giving,  251 
Precocity,  194 
Pregnancy,  amusements  in,  24 

bathing  during,  22 

care  of  breasts  during,  27 

clothing  during,  26 

diet  in,  25 

disorders  of,  28 

duration  of,  21,  23 

exercise  in,  22 

importance  of  careful  life  during,  19 


Pregnancy,  influence  on  nursing,  127 

management  of,  22 

maternal  nni^ressions,  25 

mental  condition  in,  24 

signs  of,  19 
Premature  infants,  337 
Prickly  heat,  305 
Princess  pattern,  93,  94,  95 
Prodromal  symptoms,  317 
Puberty,  18,  60,  185 
Pulse  during  sleep,  4I 

in  disease,  244 

in  health,  40,  67 

method  of  observing,  40,  41 

relation  to  temperature  and  respira- 
tion, 245 
Punishments,  190,  207 
I'ustule,  318 

Quarantine,  196,  318 
Quart,  416 
Quickening,  21 

"  Rash,  bringing  out  the,"  346,  396 

nettle-,  307 

of  eruptive  fevers,  315 

stomach,  309 

tooth,  309 
Raw  meat,  scraped,  3S6 
Read,  learning  to,  189,  194 
Record,  daily,  of  the  disease,  261,  262 
Red  gum,  305 
Refrigerator,  nursery,  233 
Registers,  217 
Regurgitation,  120,  269 
Remedies  for  internal    administration, 

413 
for  local  use,  393 
Respiration,  artificial,  375 
Cheyne-Stokes,  243 
during  sleep,  38,  39 
in  disease,  237,  240,  243 
in  health,  38-40,  67 
method  of  observing,  40 
relation  to  temperature    and    pulse, 

245 
through  the  mouth,  23S,  26S,  350 
Restlessness,  237 
Rheumatism,  341,400 
Rice-water,  383 
Rickets,  237,  239,  240,  298,  30I,  303, 

339 
Ringworm,  31 1,  406 


INDEX. 


433 


Rocking-horse,  185 
Room  for  confinement,  31 

for  school.      See  school-room. 

for  sickness.     See  Sick-room. 

for  sleeping,  176 
Rooms  for  child,  different  sorts  of,  214 
Rope,  skipping-,  185 
Roseola,  323 
Rotheln,  323 
Rubber  cloth  for  bed,  31,  32,  174,  175 

diaper- cover,  91 

garments,  114 
Rubella,  323 
Rubeola,  322 
Rupture,  277 

Sack,  98,  100,  106,  108,  115,  255 
Saint  Vitus'  dance,  289,  341 
Saliva,  61,  161,  264 

profuse  flow  in  pregnancy,  29 
Scabies,  312 
Scalds,  363 

Scales  for  weighing  child,  56 
Scarlatina,  319 
Scarlet  fever,  247,  319 

rash,  319 
School,  boarding,  196 

diseases  developed  at,  196,  234,  235 

gymnastic  exercises  at,  1 87 

kindergarten,  194 

-life,  hours  for  study,  195 

recess  at,  195 

-room,  234 

desks  and  chairs  for,  235 
lighting  of,  236 
size  required,  236 
ventilation  of,  236 
Scrofula,  341 
Scurvy,  342 
Sea-baths,  82 

-voyages  in  pregnancy,  24 
Seeing.     See  Sight. 
Self-abuse,  356 

Selfishness,  freedom  from,  191 
Sensations,  subjective,  of  baby,  50 
Servants,  association  of  child  with,  192 
Sex,  determining,  before  birth,  28 
Sexes,  difference  in  clothing  for.  III, 

sports  same  for  each,  186,  193 
supervision  of  morals  of,  193 

Sheets,  31,  32,  175 

Shirt,  93,  99,  108,  109,  113,  115 

28 


Shirt,  Gertrude,  95,  99 
Shoe,  outline  of  sole,  106 
Shoes,  bed-room,  115 

heels  to,  114 

moccasins,  104 

rights  and  lefts,  105 

rubber,  1 14 

soles  to,  106,  114 
Shoulders  at  birth,  36 

rounded,  195,  235,  356 

"shrugged  up,"  303 
"  Show  "  in  confinement,  t,t, 
Sick  children,  bathing  of,  255,  256,  393 
feeding  of,  168,  252,  261,  381 
management  of,  237,  248 
Sickness,  abstinence  from  food  during, 
253,  261,  269,  271,  275 

bathing  in,  255,  256,  393 

bed  in,  254,  255 

clothing  during,  115 

examination  by  physician  in,  259 

feeding  in,  168,  252,  261,  381 

morning,  20,  30 
Sick-room,  224 

anteroom  to,  226,  228 

deodorizing  of,  229,  256 

disinfection  of,  226 

for  contagious  diseases,  225 

furnishing  of,  225,  232,  233 

heating  of,  228 

lighting  of,  225 

moistening  air  of,  229 

neatness  in,  228 

position  of,  225 

quiet  in,  253 

temperature  of,  231 

ventilation  of,  228 
Sight  at  birth,  47 

defective,  293,  294,  295 

increase  of  power  of,  49 

in  idiocy,  291 
Sitting  erect,  48 

in  idiocy,  291 
Skating,  185 

Skin,  chapping,  chafing,  and  cracking 
of,  308 

color  of,  34,  35,  239 

irritated  by  clothing,  88,  306 

moist,  relation  to  fever,  346 

necessity  of  keeping  covered,  87,  109 

roughness  of,  308 

scraped,  359 

shedding  of,  35,  318 


434 


INDEX. 


Skirts,  no 

advantage  of  shortness,  94,  III 
Sleep  at  l)reast  not  to  be  allowed,  118 

between  blankets,  175 

durins^  the  day,  16S,  170 

effect  on  pulse,  41 
on  respiration,  40 

hours  for,  135,  16S-171 

in  disease,  237,  240 

method  of  putting  to,  169 

out  of  doors,  180 

position  during,  38,  169 

room  for,  176,  221 

starting  in,  300 
Sleeplessness,  16S,  171,  287,  396,  397 
Slip,  95 

Slippers  not  aiivisable,  115 
Small-jiox,  325 
Smell,  increase  in  sense  of,  49 

sense  of,  at  birth,  47 
Smiling,  50,  240 
Snake-bites,  361 
Snoring,  26S,  350 
Soap,  method  of  applying,  72 

stick,  273 

varieties  of,  78 
Socks,  92,  100 
Soda-mint,  413 

solution  for  milk  mixture,  143,  152 
"Soothing  drinks,"  377 
Sounds,  recognition  of,  49 

utterance  of,  51 
Spasm.     See  Convulsions. 
Specific-gravity  glass,  128,  139 
Speech.     See  also  Talk. 

defective,  353 
Spinal  cord ,  paralysis  from  d  isease  of,  290 
Spine,  curvature  of,  178,  195,  301 
angular,  302 
lateral,  234,  301 
rickety  posterior,  303 

Pott's  disease  of,  240,  302 
Splinters,  359 
Sponge,  72, 77 
Sponging,  73,  79,  255,  394 
Spoonfuls  of  different  sorts,  252,  416 
Sports  and  games,  185,  187 

out-door,  intended    for    both    sexes, 
186, 193 
Sprains,  362 
Stammering,  353 
Standing,  48,  235 
Slarch-and-boric-acid  lotion,  408 


Starch  in  the  food,  158 
age  for  allowing,  161 
difficulty  of  digesting,  161,  268 

test  for,  159 

-water,  399 
Sterilizer,  148,  149 
Sterilizing,  149 

effect  on  digestibility  of  milk,  152 

method  in  detail,  149 

modified,  152 
Stimulants  for  child,  dose  of,  420 

use  of,  by  mother,  121 
Stings  by  insects,  360 
Stockings,  102,  108,  no,  114,  115 
Stomach  cough,  243 

rash,  309 

secretion  and  movements  of,  62 

size  of,  at  birth,  133 
Stools.     See  Passages. 
Stooping,  195,  235,  356 
Stories  suitable  for  children,  193,  208 
Strabismus,  295 
Strophulus,  305 
Study.      See  also  AlincL 

hours  for,  195 

injuring  eyes  by,  195,  235,  288 
Stupe,  turpentine,  404 
Stuttering,  353 
Styes,  295 
Sucking  at  empty  bottle,  155 

of  lip,  352 

the  thumb,  351 
Suffocation,  374 
Sugar,  cane-,  142 

-measure.  144 

milk-,  142,  143 
Suit,  Gertrude,  93,  95,  96,  99,  lOI 
Summer  resorts,  186 
Sunburn,  365 
Supernumerary  digits,  298 
Suppositories,  273 
Suspenders  for  diapers,  103 

for  holding  stockings,  102,  no 
Swallowing,  maimer  of,  in  disease,  247 

of  foreign  bodies,  370 

of  poisons,  376 
Swamp  dogwood,  373 
Swetlisli  movements,  187 
Swimming,  185 
Syringe,  ear,  297,  370 

fountain,  30,  258 

infant's,  258,  273 

rubber,  259,  273 


INDEX. 


435 


Table,  sitting  at,  i66,  192 
Tables  and  Lists : 

Amounts  of  urine  passed  daily,  43 
Analysis  of  breast  milk,  137 
Approximate     analysis    of    breast 

milk,  130 
Approximate  equivalent  measures, 

416 
Articles  for  baby's  basket,  70 
for  confinement,  31 
for  medicine  closet,  421 
Calculating  date   of  confinement, 

23 
Circumference  of  head  and  chest 

at  different  ages,  60 
Clothes  for  earliest  childhood,  1 15 
Comparative  analysis  of  woman's 

and  cow's  milk,  137 
Diet  from  eighteen  months  to  two 
years,  164 
from     one     year     to     eighteen 

months,  163 
from  two  to  three  years,  165 
Doses  of   medicine    for    children 

one  year  old,  418 
Eruption  of  milk  teeth,  65 
of  permanent  teeth,  67 
Foods  permitted,  167 
to  be  avoided,  168 
to  l)e  taken  cautiously,  167 
Formula  for    milk    mixture,  143, 

146 
General  rules  for  feeding,  134 
Growth  in  length  and  weight,  53 
Hours  for  feeding,  135 
Infants'  weight  chart,  54 
Infectious  diseases,  316,  317 
Long  clothes,  100 
Number  of  pulse-beats  per  minute, 
41 
of  respirations  per  minute,  39 
Poisons  and  antidotes,  378 
Proportionate    doses    at    different 

ages,  417 
Record  of  course  of  disease,  262 
Rules  for  modifying  breast  milk, 

131 
Short  clothes,  108 
Time  of  eruption  of  milk  teeth,  65 

of  permanent  teeth,  67 
Top  milk  mixture,  146 
Tales  suitable  for  children,  193,  208 
Talk.     See  also  Speech. 


Talk,  "  baby,"  objection  to,  189 

learning  to,  189,  205 
Talking  in  idiocy,  292 
Tannic-acid-and-glycerin  nipple  lotion, 

407 
Tannic-acid    solution    for   nose-bleed, 

409 
Tanning  of  the  skin,  366 
Taste  at  l^irtli,  47 
Tears,  39,  61,  242 

and  cuts,  357 
Teeth,  cleaning  of,  84 

decay  of,  in  pregnancy,  29 
deciduous.     See  Teeth,  milk. 
grinding  of,  247,  278,  285 
milk,  63 

decay  of,  66,  S3,  266,  340 
falling  out  of,  66 
necessity  for  removing,  65,  66 
neutralizing  of  acid  medicine,  234 
time  and  order  of  eruption,  64 
permanent,  63 

time  and  order  of  eruption,  66 
present  at  birth,  65 
prominent,  352 
temporary.      See   Teeth,  viilk. 
Teething.      See  also  Dentition. 
process  of,  63 

relation  to  flow  of  saliva,  61 
Temperature-chart,  262 
in  disease,  244 
method  of  taking,  43 
normal,  43,  45 
of  bath,  72,  79,  80,  394 

testing  of,  79 
of  nursery,  218,  222 
of  sick-room,  231 

relation  to  pulse  and  respiration,  245 
sensation  of  skin  to  hand  misleading, 

43 
Tennis,  185 
Thermometer,  bath,  78 

clinical,  43,  44,  346 

nursery,  218 
Thirst,  118,  241,  252,  253,  347 
Throat,  applications  to,  259 

sore,  267,  401 
Thrush,  265 
Thumb-sucking,  351 
Toast-water,  3S3 
Tongue  at  birth,  36 

in  disease,  246 

strawberry,  320 


436 


INDEX. 


Tongue-tie,  264 

"worm-eaten,"  268 
Tonsils,  acute  intiammation  of,  267 

chronic  enlargement  of,  238,  268 
Toothache,  297 

in  pregnancy,  29 
Tooth  rash,  309 

rubbing,  through  the  gums,  266 
Tourniquet,  358 
Towels  for  bathing,  81 
Toys,  188 

poisonous,  377 
Trained  nurse.     See  Nurse. 
Training  to  control  bladder,  184 

intellect  and  morals,  1 87- 1 96 

to  go  to  sleep,  169 

-school  for  nurse-maids,  206 
Travelling,  food  for,  151,  160 
Trotting  on  knee,  184 
Tub,  73,  74,  76 
Tumblerful,  416 
Typhoid  fever,  318 
cold  bath  in,  396 

Underclothes.     See  Clothing. 
Urine,  amounts   passed  daily  at  differ- 
ent ages,  43 

frequent  passage  of,  in  pregnancy,  29 

in  Bright's  disease,  247,  348 

incontinence  of,  348 

in  disease,  247 

in  health,  42,  67 

learning  control  over,  52,  109,  184 

pain  on  passing,  348,  349 

retention  of,  42,  348 
Urinometer,  139 
Urticaria,  307 

Vaccination,  327 

Varicella,  324,  326 

Variola,  316 

Varioloid,  324,  325 

Veal  tea,  385 

Veil,  98,  100,  108 

Veins,  prominence  of,  239 

varicose,  in  pregnancy,  29 
Velocipede,  185 
Ventilating  board,  216 
Ventilation,    175,   215-218,   222,   228, 

236 
Ventilator,  wheel,  217 


Ventilator,  window,  216 
Vesicle,  318 
Virginia  creeper,  372 
Vision.      See  Sight. 
Vomiting,  253,  261,  269 

Waist  for  supporting    clothing,    103, 

no 
Walk,  learning  to,  48,  182 

stiff,  303 
Walking,  discouraging  of,  340 

in  idiocy,  291 

pigeon-toed,  49 
Warmth,  necessity  of,  87,  109,  338 
W^arts,  305 
Wash-rag,  72,  76,  77 

-stand  in  nursery,  221 
Water,  necessity    of  giving,  118,  241, 
252,  253,  347 

on  the  brain.  See  Hydrocephalus. 
Waxy  substance  on  skin  at  birth,  71 
Weaning,  124,  162 

age  for,  125 

early,  reasons  for,  126 

method  of,  124,  126 

season  of  year  for,  125 
Weather-stripping,  218 
Webbing  of  fingers  or  toes,  298 
Weight  at  birth,  34,  53 

charts  for  recording,  55 

increase  in,  52-55 

method  of  obtaining,  55 
Wet-nurse.     See  A'lirse. 
Wetting  the  bed,  348 
Whey,  384 

-and-cream  mixture,  160,  385 
Whooping-cough,  239,  246,  332 
Window  bars,  219 
Wine  whey,  385 
Wineglassful,  416 
Woollen  underwear,  88 
Worms,  round,  278 

seat-,  278,  410 

tape-,  279,  386 

thread-,  278,  410 
Wounds,  incised,  357 

lacerated,  358 

of  the  eye,  369 

poisoned,  360 

punctured,  359 
Wrapper,  98,  100,  106,  108,  115 


CATALOGUE 


OP 


Books  ON  nursing 

AND  BOOKS  SPECIALLY  IN= 
TERESTINQ   FOR  NURSES 


Books  sent  to  any  address,  prepaid,  on  receipt  of 
the  price  herein  given 

PAGE 

Abbott's  Hygiene  of  Transmissible  Diseases lo 

American  Pocket  Medical  Dictionary 7. 

American  Illustrated  Medical  Dictionary 9 

Bergey's   Principles  of  Hygiene, g 

Chapin's  Compendium  of  Insanity,      4 

Davis's  Obstetrical   Nursing, 3 

Galbraith's  Four  Epochs  of  Woman's  Life     . 6 

Grafstrom's  Mechano-Therapy 6 

Griffith's  Care  of  the  Baby, 5 

Griffith's  Infant's  Weight  Chart, 5 

Laine's  Temperature  Chart     9 

Martin's  Essentials  of  Minor  Surgery  and  Bandaging 8 

Meigs's  Feeding  in   Early  Infancy 6 

Morris's  Essentials  of  Materia    Medica,   Therapeutics,  and    Prescrip- 
tion-Writing    7 

Nancrede's   Essentials  of  Anatomy                    8 

Pye's  Elementary  Bandaging  and  Surgical  Dressing 6 

Pyle's  Personal  Hygiene 5 

Stevens's  Manual  of  Materia  Medica  and  Therapeutics 7 

Stevens's  Manual  of  Practice  of   Medicine 7 

Stoney's  Materia  Medica  for  Nurses 4 

Stoney's   Practical  Points  in   Nursing 2 

Stoney's  Surgical  Technic  for  Nurses  .       3 

Warwick  and  Tunstall's  First  Aid  to  the  Injured  and  Sick 10 

Watson's  Handbook  for  Nurses 4 

W.  B.  SAUNDERS  &  CO. 

925  WALNUT  ST.  PHILADELPHIA. 

NEW  YORK  LONDON 


Practical  Points  in  Nursing,  just  issued 

^1— ^—  -^^— — ^^— ^—  Third  Bdition, 

for  Nurses  in  Private  Practice.  ThorouKhiy  Revised, 

By  Emily  A.  M.  Stoni;v,  Superintendent  of  the  Training- 
School  for  Nurses  in  the  Carney  Hospital,  South  Boston,  Mass. 
466  pages,  handsomely  illustrated.     Cloth.     Price,  $1.75  net. 

In  this  volume  the  author  explains  the  entire  range  of  private 
nursing  as  distinguished  from  hospital  nursing,  and  the  nurse  is 
instructed  how  best  to  meet  the  various  emergencies  of  medical 
and  surgical  cases  when  distant  from  medical  or  surgical  aid  or 
when  thrown  on  her  own  resources.  An  especially  valuable  feat- 
ure of  the  work  will  be  found  in  the  directions  to  the  nurse  how 
to  improvise  everything  ordinarily  needed  in  the  sick-room. 

The  Appendix  contains  much  information  that  will  be  found 
of  great  value  to  the  nurse,  including  Rules  for  Feeding  the  Sick  ; 
Recipes  for  Invalid  Foods  and  Beverages  ;  Tables  of  Weights  and 
Measures;  List  of  Abbreviations;  Dose-List;  and  a  complete 
Glossary  of  Medical  Terms  and  Nursing  Treatment. 

"  This  is  a  well-written,  eminentlv  practical  volume,  which  covers  the  entire 
range  of  private  nursing,  and  instructs  the  nurse  how  to  meet  the  various  emer- 
gencies which  mav  arise  and  how  to  prepare  everything  needed  m  the  illness  of 
her  ^2X\z\\\.:'— American  Journal  of  Obstetrics  and  Diseases  of  Women  and  Children. 

The  American  Pocket  Medical  Dictionary. 

Third  Edition,  Revised. 

Edited  bv  W.  A.  Newman  Borland,  M.D.,  Assistant  Obstet- 
rician to  the  Hospital  of  the  University  of  Pennsylvania  ;  Fellow 
of  the  American  Academy  of  Medicine,  etc.  Handsomely  bound 
in  flexible  leather,  limp,  with  gold  edges  and  patent  thumb  index. 
Price,  $1.00  net ;   with  patent  thumb  index,  $1.25  net. 

This  is  the  ideal  pocket  lexicon.  It  is  an  absolutely  new  book, 
and  not  a  revision  of  any  old  work.  It  gives  the  pronunciation 
of  all  the  terms.  It  contains  a  complete  vocabulary,  defining 
all  the  terms  of  modern  medicine.  It  makes  a  special  feature 
of  the  newer  words  neglected  by  other  dictionaries.  It  con- 
tains a  wealth  of  anatomical  tables  of  special  value  to  students. 
It  forms  a  volume  indispensable  to  every  medical  man  and  nurse. 

"  I  am  struck  at  once  with  admiration  at  the  compact  size  and  attractive 
exterior.  I  can  recommend  it  to  our  students  without  reserve.'— James  W. 
Holland,  M.  D.,  Dean  of  Jefferson  Medical  College,  Philadelphia. 

"  Since  the  reviewer  has  had  the  work  lying  on  his  table  waiting  for  review 
he  has  had  frequent  occasion  to  consult  it,  and  he  has  not  been  disappomted  m  it. 
We  heartily  commend  the  work."— 7%(?  Practitioner,  London. 


2 


Obstetric  and  Gynecologic  Nursing. 

By  Edward  P.  Davis,  A.M.,  M.D.,  Professor  of  Obstetrics  in 
the  Jefferson  Medical  College  and  the  Philadelphia  Polyclinic ; 
Obstetrician  and  Gynecologist  to  the  Philadelphia  Hospital. 
i2mo  volume  of  402  pages,  fully  illustrated.     Buckram,  $1.75  net. 

RECENTLY  ISSUED. 

This  volume  is  designed  to  furnish  instruction  as  to  the  various 
duties  of  the  obstetric  nurse.  Obstetric  nursing  demands  some 
knowledge  of  natural  pregnancy  and  of  the  signs  of  accidents 
and  diseases  which  may  occur  during  pregnancy.  It  also  requires 
knowledge  and  experience  in  the  care  of  the  patient  during  the 
labor  and  her  complete  recovery,  with  the  needs  of  her  child. 
Gynecologic  nursing  is  really  a  branch  of  surgical  nursing,  and  as 
such  requires  special  instruction  and  training,  thorough  knowledge 
and  drill  in  asepsis  and  antisepsis  being  absolutely  indispensable. 

"This  is  one  of  the  most  practical  and  useful  books  ever  presented  to  the 
nursing  profession." — Trained  Nurse  and  Hospital  Review. 

"  Not  only  nurses,  but  even  newly  qualified  medical  men,  would  learn  a  great 
deal  by  a  perusal  of  this  book.  ...  A  work  we  can  recommend." — The  Lancet, 
London. 

Bacteriology  and  Surgical 
Technic  for  Nurses. 

By  Emily  A.  M.  Stoney,  Superintendent  of  the  Training- 
School  for  Nurses  in  the  Carney  Hospital,  South  Boston,  Mass. 
i2mo  volume,  fully  illustrated.      Price,  Cloth,  $1.25  net. 

The  work  is  intended  as  a  modern  text-book  on  Surgical  Nurs- 
ing in  both  hospital  and  private  practice.  The  first  part  of  the 
book  is  devoted  to  Bacteriology  and  Antiseptics ;  the  second  part 
to  Surgical  Technic,  Signs  of  Death,  and  Autopsies.  The  matter 
in  the  book  is  presented  in  a  practical  form,  and  will  prove  of 
value  to  all  nurses  who  are  called  upon  to  attend  surgical  cases. 

"  Nurses  will  find  this  book  of  the  greatest  value  both  during  their  hospital 
course  and  in  private  practice." — Trained  Nurse  and  Hospital  Rcviciu. 

"This  is  an  admirable  little  book.  It  is  exceedingly  practical." — New  York 
Medical  Journal. 

3 


A   Handbook  for  Nurses.  Recently  issued. 

By  J.  K.  Watson,  M.D.,  Edin.,  Assistant  House-Surgeon, 
Sheffield  Royal  Hospital.  American  Edition,  under  the  super- 
vision of  A.  A.  Stevens,  A.M.,  M.D.,  Prolessor  of  Pathology, 
Woman's  Medical  College,  Philadelphia.  i2mo,  413  pages,  73 
illustrations.     Cloth,  $1.50  net. 

This  work  aims  to  supply  in  one  volume  that  information  which  so  many 
nurses  at  the  present  time  are  trying  to  extract  from  various  medical  works,  and 
to  present  that  information  in  a  suitable  form.  The  book  represents  an  entirely 
new  departure  in  nursing  literature,  insomuch  as  it  contains  useful  information 
on  medical  and  surgical  matters  hitherto  only  to  be  obtained  from  expensive 
works  written  expressly  for  medical  men. 

Materia  Medica  for  Nurses. 

By  Emily  A.  M.  Stoney,  Superintendent  of  the  Training- 
School  for  Nurses  in  the  Carney  Hospital,  South  Boston,  Ma.ss. 
Handsome  octavo  volume  of  300  pages.    Cloth.    Price,  $1.50  net. 

The  present  book  differs  from  other  similar  works  in  several 
features,  all  of  which  are  intended  to  render  it  more  practical  and 
generally  useful.  The  consideration  of  the  drugs  includes  their 
names,  their  sources  and  composition,  their  various  preparations, 
physiologic  actions,  directions  for  handling  and  administering, 
and  the  symptoms  and  treatment  of  poisoning.  The  Appendix 
contains  much  practical  matter,  such  as  Poison-emergencies, 
Ready  Dose-list,  Weights  and  Measures,  etc.,  as  well  as  a  Glossary, 
defining  all  the  terms  used  in  Materia  Medica,  and  describing  all 
the  latest  drugs  and  remedies,  which  have  been  generally  ne- 
glected by  other  books  of  the  kind. 

A  Compendium  of  Insanity. 

By  John  B.  Chapin,  M.D.,  LL.D.,  Physician-in-Chief,  Penn- 
sylvania Hospital  for  the  Insane.  i2mo,  234  pages,  illustrated. 
Cloth,  $1.25  net. 

The  author  has  given,  in  a  condensed  and  concise  form,  a 
compendium  of  Diseases  of  the  Mind,  for  the  convenient  use  and 
aid  of  physicians  and  students.  It  contains  a  clear,  concise  state- 
ment of  the  clinical  aspects  of  the  various  abnormal  mental  con- 
ditions, with  directions  as  to  the  most  approved  methods  of  man- 
aging and  treating  the  insane. 

"  The  practical  parts  of  Dr.  Chapin's  book  are  what  constitute  its  distinctive 
merit.  We  desire  especially,  however,  to  call  attention  to  the  fact  that  in  the 
subject  of  the  therapeutics  of  insanity  the  work  is  exceedingly  valuable.  The 
author  has  made  a  distinct  addition  to  the  literature  of  his  specialty." — Phila- 
delphia Medical  Journal. 

4 


A  Manual  of  Personal  Hygiene.     Recently  issued. 

Proper  Living  upon  a  Physiologic  Basis.  By  American  Authors. 
Edited  by  Walter  L.  Pyle,  A.M.,  M.D.,  Assistant  Surgeon  to 
Wills  Eye  Hospital,  Philadelphia.  Octavo,  350  pages.  Pro- 
fusely illustrated.     Cloth,  $1.50  net. 

The  object  of  this  manual  is  to  set  forth  plainly  the  best  means  of  develop- 
ing and  maintaining  physical  and  mental  vigor.  It  represents  a  thorough  exposi- 
tion of  living  upon  a  physiologic  basis.  There  are  cliapters  upon  the  hygiene 
of  the  digestive  apparatus,  the  sliin  and  its  appendages,  the  vocal  and  respiratory 
apparatus,  eye,  ear,  brain,  and  nervous  system,  and  a  chapter  upon  exercise. 
The  book  is  the  conjoint  work  of  several  well-known  American  physicians  and 
medical  teachers,  each  writing  upon  a  subject  to  which  he  has  given  special 
study. 

"The  work  has  been  excellently  done  :  there  is  no  undue  repetition,  and  the 
writers  have  succeeded  unusually  well  in  presenting  facts  of  practical  significance 
based  on  sound  knowledge." — Boston  Medical  and  Surgical  Journal. 

"Good  common-sense  advice  as  to  the  matter  of  personal  hygiene." — Bulle- 
tin of  Johns  Hopkins  Hospital. 

The  Care  of  the  Baby.  ■^^S'S^^Z^. 

By  J.  P.  Crozer  Griffith,  M.D.,  Clinical  Professor  of  Dis- 
eases of  Children,  University  of  Pennsylvania ;  Physician  to  the 
Children's  Hospital,  Philadelphia,  etc.  436  pages,  w^ith  67  illus- 
trations in  the  text,  and  5  plates.      i2mo.     Price,  $1.50  net. 

"The  whole  book  is  characterized  by  rare  good  sense,  and  is  evidently 
written  by  a  master  hand.  It  can  be  read  with  benefit  not  only  by  mothers,  but 
by  medical  students  and  by  any  practitioners  who  have  not  had  large  oppor- 
tunities for  observing  children." — American  Journal  of  Obstetrics. 

Infantas  Weight  Chart. 

Designed  by  J.  P.  Crozer  Griffith,  M.D.,  Clinical  Professor 
of  Diseases  of  Children  in  the  University  of  Pennsylvania.  25 
charts  in  each  pad.     Price  per  pad,  50  cents  net. 

A  convenient  blank  for  keeping  a  record  of  the  child's  weight 
during  the  first  two  years  of  life.  Printed  on  each  chart  is  a 
curve  representing  the  average  weight  of  a  healthy  infant,  so  that 
any  deviation  from  the  normal  can  readily  be  detected. 

Feeding  in  Early  Infancy. 

By  Arthur  V.  Meigs,  M.D.  Bound  in  limp  cloth,  flush 
edges.     Price,  25  cents  net. 


Four   Epochs   of    Woman's    Life, 

^^^^^^^^^~^^"~"~"~'^~'^""  ^~~'^~~^"^*""~~"^      Recently  Issued. 

Maidenhood,  Marriage,  Alaternitv,  Menopause. 

A  Study  in  Hygiene.  By  Ann.\  M.  Galbraith,  M.  D., 
Author  of  ''  Hygiene  and  Physical  Culture  for  Women  ;"  with  an 
Introductory  Note  by  John  H.  Misskk,  M.I).,  Professor  of 
Clinical  Medicine,  University  of  Pennsylvania.  i2mo,  200 
pages.     Cloth,  $1.25  net. 

In  this  instructive  work  are  stated,  in  a  modest,  j^leasing,  and 
conclusive  manner,  those  truths  of  which  every  woman  should 
have  a  thorough  knowledge.  The  subject  is  discussed  in  language 
readily  grasped  even  by  those  unfamiliar  w^ith  medical  subjects. 

"  Tlie  author  has  treated  a  difficult  subject  with  tact,  wisdom,  and  dignity." 
— American  Medicine. 

A  Text=Book  of  Mechano=Therapy 

(Massage  and  Medical  Gymnastics). 

By  Axel  V.  Grafstrom,  B.  Sc,  M.D.,  late  Lieutenant  in  the 
Royal  Swedish  Army ;  late  House  Physician,  City  Hospital, 
Blackwell's  Island,  New  York.  i2mo,  139  pages,  illustrated. 
Cloth,  1 1. 00  net. 

This  book  is  intended  as  a  practical  manual  of  the  methods  of 
massage  and  Swedish  movements,  so  rapidly  becoming  popular  in 
this  country.  It  describes  clearly  and  shows  by  illustration  the 
various  movements  of  the  system  and  their  mode  of  application 
to  all  parts  of  the  body,  and  indicates  definitely  the  particular 
ones  applicable  to  the  various  conditions  of  disease. 

Elementary  Bandaging  and 
Surgical  Dressing. 

With  Directions  concerning  the  Immediate  Treatment  of  Cases 
of  Emergency.  By  Walter  Pye,  F.R.C.S.,  late  Surgeon  to  St. 
Mary's  Hospital,  London.  Small  i2mo,  with  over  80  illustra- 
tions.    Cloth,  fle.xible  covers,  75  cents  net. 

This  little  book  is  chiefly  a  condensation  of  those  portions  of 
Pye's  "Surgical  Handicraft"  which  deal  with  bandaging,  splint- 
ing, etc.,  and  of  those  which  treat  of  the  management  in  the  first 
instance  of  cases  of  emergency.  'Phe  directions  given  are  thor- 
oughly practical,  and  the  book  will  prove  extremely  useful  to 
students,  surgical  nurses,  and  dressers. 

"  The  author  writes  well,  the  diagrams  are  clear,  and  the  book  itself  is  small 
and  portable,  although  the  paper  and  type  are  good." — British  Medical  Journal. 

6 


A  Manual  of  Practice  of  Medicine, 

Fifth  Edition,  Revised  and  Enlarged. 

By  A.  A.  Stevens,  A.M.,  M.D.,  Instructor  in  Physical  Diag- 
nosis in  the  University  of  Pennsylvania,  and  l^rofessor  of  Pathol- 
ogy in  the  Woman's  Medical  College  of  Pennsylvania.  Post  8vo, 
519  pages.  Numerous  illustrations  and  selected  formulas.  Price, 
bound  in  flexible  leather,  ^2.00  net. 

It  is  well-nigh  impossible  for  the  student,  with  the  limited 
time  at  his  disposal,  to  master  elaborate  treatises  or  to  cull  from 
them  that  knowledge  which  is  absolutely  essential.  From  an  ex- 
tended experience  in  teaching,  the  author  has  been  enabled,  by 
classification,  to  group  allied  symptoms,  and  to  bring  within  a 
comparatively  small  compass  a  complete  outline  of  the  practice 
of  medicine. 

A  Text=Book  of  Modern  Therapeutics. 

Third  Edition,  Revised  and  Greatly  Enlarged. 

By  A.  A.  Stevens,  A.  M.,  M.D.,  Lecturer  on  Physical  Diag- 
nosis, University  of  Pennsylvania.  Handsome  octavo  volume  of 
about  600  pages.     Cloth,  $0.00  net. 

This  wholly  new  volume,  which  is  based  on  the  last  edition 
of  the  Pharmacopxia,  comprehends  the  following  sections  :  Phys- 
iological Action  of  Drugs ;  Drugs ;  Remedial  Measures  other 
than  Drugs  ;  Applied  Therapeutics  ;  Incompatibility  in  Prescrip- 
tions ;  Table  of  Doses  ;  Index  of  Drugs  ;  and  Index  of  Diseases, 
the  treatment  being  elucidated  by  more  than  two  hundred  formulae. 

"  The  author  has  faithfully  presented  modern  therapeutics  in  a  comprehensive 
work,  .  .  .  and  it  will  be  found  a  reliable  guide  and  sufficiently  comprehensive." 
—  University  of  Pennsylvania  Medical  Bulletin. 

Essentials  of  Materia  Medica,  Thera=      Fifth 

^^^^■""^^^^^^^"^^^^^^^^^^^^"■"^^^^^^^^^^^^"^^^^^        Edition, 

peutics,  and  Prescription=Writing.  Revised. 

By  Henry  Morris,  M.D.,  late  Demonstrator  of  Therapeutics, 
Jefferson  Medical  College,  Philadelphia ;  Fellow  of  the  College 
of  Physicians,  Philadelphia,  etc.  Crown  octavo,  288  pages. 
Cloth,  ^i.oo;  net;  interleaved  for  notes,  $1.25  net. 

"  Has  more  value  than  some  of  the  numerous  manuals  which,  though  more 
pretentious,  are  neither  fuller  nor  more  accurate." — Bulletin  of  Johns  Hopkins 
Hospital. 

7 


Essentials  of  Anatomy, 

•^  *  Sixth 

Including  the  Anatomy  of  the  Viscera.  Edition. 

By  C'haki.es  11.  Nanckkde,  M.I).,  Professor  of  Surgery  and 
of  Clinical  Surgery  in  the  University  of  Michigan,  Ann  Arbor. 
Crown  octavo,  388  pages;  180  illustrations.  With  an  Ap])endix 
containing  over  60  illustrations  of  the  osteology  of  the  human 
body.  Based  upon  Gray' s  Anatomy.  Cloth,  $1.00  net;  inter- 
leaved for  notes,  $1.25  net. 

"A  useful  little  book  which  has  been  approved  by  long  service  in  medical 
schools  and  training-schools  for  nurses.  It  is  concise  without  the  sacrifice  of 
clearness,  and  the  excellent  illustrations  assist  the  text." — Bulletin  of  Johns 
Hopkins  Hospital. 

Essentials  of  Minor  Surgery,  Bandaging, 

and  Venereal  Diseases,     second  Edition,  Revised. 

By  Edward  Martin,  A.  M.,  M.  D.,  Professor  of  Clinical  Sur- 
gery, University  of  Pennsylvania.  Crown  octavo,  166  pages,  with 
78  illustrations.    Cloth,  $1.00  net ;  interleaved  for  notes,  51-25  net. 

"  The  best  condensation  of  the  subjects  of  which  it  treats  yet  placed  before 
the  profession." — The  Medical  News,  Philadelphia. 

Bergey's  Principles  of  Hygiene.       Recently  issued. 

The  Principles  of  Hygiene  :  A  Practical  Manual  for  Students, 
Physicians,  and  Health" Officers.  By  D.  H.  Bkrgky,  A.  M., 
M.  D.,  First  Assistant,  Laboratory  of  Hygiene,  University  of 
Pennsylvania.  Handsome  octa\o  volume  of  495  pages,  illus- 
trated.    Cloth,  $3.00  net. 

"  Many  practical  suggestions  that  cannot  fail  to  be  of  much  value  in  their 
respective  departments.  "Sound  and  practical  is  the  verdict  on  the  book."— 
Birmingham  Medical  Review,  England. 

Temperature  Chart. 

Prepared  by  D.  T.  Laine,  M.  D.  Size,  8x131^  inches.  Price, 
per  pad  of  25  charts,  50  cents  net. 

A  conveniently  arranged  chart  for  recording  Temperature,  with 
columns  for  daily  amounts  of  Urinary  and  Fecal  Excretions,  Food, 
Remarks,  etc.  On  the  back  of  each  chart  is  given  in  full  the 
method  of  Brand  in  the  treatment  of  Typhoid  Fever. 


RECENTLY  ISSUED-SECOND  EDITION 

The  American   Illustrated  Get  the  Best 

Medical  Dictionary.  The  New  standard 

FIRST  EDITION  EXHAUSTED  IN  EIGHT  MONTHS. 

A  New  and  Complete  Dictionary  of  the  terms  used  in  Medi- 
cine, Surgery,  Dentistry,  Pharmacy,  Chemistry,  and  kindred 
branches ;  together  with  new  and  elaborate  Tables  of  Arteries, 
Muscles,  Nerves,  Veins,  etc.  ;  of  Bacilli,  Bacteria,  Micrococci, 
etc.  ;  Eponymic  Tables  of  Diseases,  Operations,  Signs  and  Symp- 
toms, Stains,  Tests,  Methods  of  Treatment,  etc.  By  W.  A.  N. 
DoRLAND,  M.  D.  Large  octavo,  nearly  800  pages,  bound  in  full 
flexible  leather.     Price,  ^4.50  net;  with  thumb  index,  $5.00  net. 

.  SECOND  EDITION,  REVISED,  WITH  ALL  THE  NEWEST 

TERMS. 

It  furnishes  a  maximum  amount  of   matter   in  a  minimum 
space,  and  at  the  lowest  possible  cost. 

This  is  an  entirely  new  and  unique  work  for  students  and  practi- 
tioners. It  contains  more  than  twice  the  matter  in  the  ordinary 
students'  dictionary,  and  yet,  by  the  use  of  clear,  condensed  type 
and  thin  paper  of  the  finest  quality,  it  forms  an  extremely  handy 
volume  only  one  and  five-eighth  inches  thick.  It  is  bound  in 
flexible  leather,  and  is  just  the  kind  of  a  book  that  one  will  want  to 
keep  on  his  desk  for  constant  reference.  It  is  absolutely  up-to-date, 
containing  hundreds  of  important  new  terms  not  to  be  found  in  any 
other  dictionary.  It  is  also  extremely  rich  in  the  matter  of  tables, 
containing  over  one  hundred  original  ones,  including  new  tables 
of  Stains  and  Staining  Methods,  Tests,  etc.  An  important  feature 
of  the  book  is  its  handsome  illustrations  and  colored  plates  drawn 
especially  for  the  work,  including  new  colored  plates  of  Arteries, 
Nerves,  Veins,  Bacteria,  Blood,  Karyokinesis,  etc. — twenty-four 
in  all. 

"  Dr.  Borland's  dictionary  is  admirable.  It  is  so  well  j^ottrn  up  and  of  such 
convenient  size.  No  errors  have  been  found  in  my  use  of  it." — H()WAK1>  A. 
Kelly,  M.D.,  Professor  of  Gynecology,  Johns  Hopkins  University,  Baltimore, 

"  I  must  acknowledge  my  astonishment  at  seeing  how  much  he  has  condensed 
within  relatively  small  space.  I  find  nothing  to  criticise,  very  much  to  commend, 
and  was  interested  in  finding  some  of  the  new  words  which  are  not  in  other 
dictionaries." — RosWF.LL  PARK,  Professor  of  Principles  and  Practice  of  Siirgety 
and  Clinical  Surgery,  University  of  Buffalo. 

9 


The  Hygiene  of  Transmissible  Diseases. 

Second  Edition,  Revised  and  Enlarged. 

The  Hygiene  of  Transmissible  Diseases :  their  Causation, 
Modes  of  Dissemination,  and  Methods  of  Prevention.  By  A. 
C.  Abbott,  M.D.,  Professor  of  Hygiene  and  Bacteriology,  Uni- 
versity of  Pennsylvania.  Octavo,  31  t  pages,  with  numerous 
illustrations.     Cloth,  $2.50  net. 

This  book  is  devoted  to  that  most  important  branch  of  the 
science  of  hygiene,  namely,  the  prevention  of  contagious  disease. 
It  deals  most  fully  with  sanitary  laws,  especially  those  concerning 
the  causation  and  spread  of  disease  and  the  means  of  prevention. 
It  treats  of  modes  of  infection,  methods  of  disinfection,  the 
means  for  the  isolation  of  the  sick,  and  the  general  rules  for  the 
management  of  contagious  diseases.  It  is  a  book  of  the  very 
greatest  value  to  the  nurse. 

"  The  book  is  well  calculated  to  meet  a  want  which  has  been  long  felt  by 
physicians  and  nurses." — Bulletin  of  Johns  Hopkins  Hospital. 

"  The  medical  student  or  practitioner  wishing  to  obtain  a  clearly  written  and 
accurate  conspectus  of  the  subjects  enumerated  above  will  find  this  volume  very 
useful. ' ' — British  Medical  Journal. 

"  It  is  scientific,  but  not  too  technical ;  it  is  as  complete  as  our  present-day 
knowledge  of  hygiene  and  sanitation  allows,  and  it  is  in  harmony  with  the  efforts 
of  the  profession,  which  are  tending  more  and  more  to  methods  of  prophylaxis." 
—  The  Medical  News. 

First  Aid  to  the  Injured  and  Sick. 

First  Aid  to  the  Injured  and  Sick.  By  F.  J.  Warwick,  B.  A., 
M.B.  Cantab.,  of  London,  and  A.  C.  Tunstall,  M.  D.,  F.  R.  C.  S. 
Ed.,  of  London.  i6mo  volume  of  232  pages  and  over  200  illus- 
trations.    Cloth,  $1.00  net. 

This  volume  of  practical  information  is  intended  as  an  aid  in  rendering  im- 
mediate tem|)orary  assistance  to  a  person  suffering  from  on  accident  or  sudden 
illness  until  the  arrival  of  a  physician.  The  importance  of  first  aid  is  indisput- 
able as  a  life-saving  expedient,  for  upon  the  promptness  and  efficiency  of  the  aid 
first  rendered  the  patient  depends,  in  a  great  measure,  the  termination  of  the 
case.  This  volume  will  be  found  a  most  useful  book  of  ready  aid,  and  of  invalu- 
able service,  not  only  to  nurses,  railway  employees,  etc.,  but  also  to  the  laity 
in  general,  as  a  book  of  indispensable   first  aids. 

"  It  is  a  book  well  adapted  for  the  instruction  of  nurses  and  hospital  corps 
orderlies  ...  It  well  fills  the  purpose  for  which  it  was  written." — Philadelphi* 
Medical  Journal. 

10 


